New

Provider Dispute Resolution Specialist - Hybrid - 141256

UC San Diego
Unclassified - No data available
United States, California, San Diego
Sep 17, 2026
UCSD Layoff from Career Appointment: Apply by 09/21/26 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor. Reassignment Applicants: Eligible Reassignment clients should contact their Disability Counselor for assistance. This position has recently been accreted by UAW RP union and will be a part of that union moving forward. This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive (San Diego, CA) and remote. DESCRIPTION Responsible for end-to-end claims appeal process including, but not limited to, claim appeal intake, categorization, acknowledgement, resolution, documentation, provider notification, claim reprocessing, tracking, trending and reporting. MINIMUM QUALIFICATIONS Six (6) years of related experience, education/training, OR a Bachelor's degree in related area plus two (2) years of related experience/training. Related experience: processing professional and facility claims within Epic Tapestry. Working knowledge of common organization- or research-specific and other computer application programs. Proficient in communication and interpersonal skills to communicate effectively, both verbally and in writing. Proficient in ability to use discretion and maintain all confidentiality. Demonstrates ability to use sound judgment in responding to issues and concerns Demonstrates ability to analyze, research and synthesize large amounts of data with strong attention to detail. Proficient in ability to multi-task with demanding timeframes. Working knowledge of applicable policy analysis techniques. PREFERRED QUALIFICATIONS Experience reviewing, approving and denying claim appeals in Epic Tapestry. Experience interpreting Division of Financial Responsibility (DOFR) agreements and delegated claims payment responsibilities. Knowledge of California provider dispute resolution requirements and managed care regulatory standards. SPECIAL CONDITIONS Must be able to work various hours and locations based on business needs. Employment is subject to a criminal background check and pre-employment physical. Pay Transparency Act Annual Full Pay Range: Unclassified - No data available (will be prorated if the appointment percentage is less than 100%) Hourly Equivalent: Unclassified - No data available Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).