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