PDR Processor

Job Description

Summary:

Responsible for accurate review, input, and processing of Provider Disputes in accordance with outside regulation, internal production standards and contractual obligations of the organization.

Duties and Responsibilities:

· Open and sort the PDR Mail, including electronically submitted PDRs.

· Accurately review all incoming PDRs and identify if they are true PDRs.

· Accurately enter PDR data information on the PDR acknowledgement form and into the computerized claims adjudication system

· Accurately generate letters through our letter generating system

· Maintain all required documentation of the PDRs

· Adjudicate PDRs in accordance with departmental policies and procedures and other rules applicable to specialty claims.

· Maintain production standards established by claims management.

· Coordinate resolution of claims issues with other departments or payers.

· Assist other departments in claims research

· Provide backup for other examiners within the department.

· Promote a spirit of cooperation and understanding among all personnel

· Attend organizational meetings as required

· Adhere to organization policies and procedures

Minimum Job Requirements:

· High school diploma.

· Work from home.

Skills and Abilities:

· Strong organizational skills.

· Knowledge of computers

· Ability to be flexible in high volume setting

Full-time