• Manage provider disputes from initial intake through final resolution, ensuring adherence to regulatory timeframes, state prompt-pay requirements, and internal SLAs. • Review and validate all incoming dispute submissions to confirm completeness; identify and communicate deficiencies to providers in a timely and professional manner. • Accurately log, track, and maintain dispute inventories within Salesforce or applicable case management systems, ensuring real-time case status visibility. • Prioritize and manage a high-volume caseload while maintaining accuracy, thoroughness, and compliance with established turnaround standards. • Identify when cases require escalation to senior staff, management, legal, or other internal departments and facilitate appropriate handoffs. • Conduct thorough, independent research into disputed claims by reviewing EOBs, remittance advice, claim histories, coordination of benefits (COB) determinations, eligibility records, provider contracts, fee schedules, and applicable benefit language. • Investigate root causes of payment discrepancies, including contract misapplication, coding errors, system configuration issues, benefit plan misinterpretation, and eligibility discrepancies. • Evaluate new information and documentation submitted by providers against the original claim decision. • Review all relevant information — including the original determination rationale, supporting documentation, and any new evidence — to independently assess whether a reversal or modification of the original decision is warranted. • Apply knowledge of CPT, HCPCS, ICD-10, revenue codes, and billing guidelines to evaluate the validity of disputed charges and determine appropriate payment outcomes. • Analyze and interpret complex provider requests, identify the specific issue(s) raised, and determine the most appropriate and complete course of action for resolution. • Review applicable state and federal regulations, internal policies, and provider contract terms to support well-reasoned dispute determinations. • Gather, organize, and evaluate all pertinent documentation — including claim history, supporting provider correspondence, and system notes — to build a complete case record prior to issuing a determination. • Initiate and process claim adjustments for disputes determined to be valid, ensuring corrections are applied accurately and completely in claims processing systems. • Remediate impacted claims identified through the dispute process, including bulk adjustments when systemic errors are identified. • Verify that adjusted claims are reprocessed in accordance with the correct contract, benefit, and coding guidelines, and that resulting payments are accurately issued. • Validate adjustment outcomes post-processing and communicate finalized results to providers in a clear and timely manner. • Document all adjustment actions, rationale, and outcomes in the case management system for audit-readiness and regulatory reporting. • Draft clear, professional, and well-supported written responses to providers for all dispute determinations — both upheld and overturned — ensuring that all points raised by the provider are directly and thoroughly addressed. • Compose acknowledgment letters, resolution letters, and reconsideration notices in accordance with regulatory requirements and internal communication standards. • Ensure all written correspondence is accurate, concise, free of jargon, and appropriate for the intended audience, whether a billing department, practice manager, or hospital administrator. • Maintain consistent, professional communication throughout the dispute lifecycle, including follow-up correspondence when additional information is requested. • Serve as a knowledgeable resource for providers navigating the dispute and adjustment process, responding to inquiries in a timely and informative manner. • Analyze dispute and adjustment trends to identify patterns in claim adjudication errors, billing code misapplication, contract misinterpretation, or system configuration issues. • Partner with the VP of Operations to develop and implement corrective action plans based on findings from dispute and adjustment activity. • Translate dispute data and root cause analysis into actionable insights and present recommendations to leadership to improve workflows, reduce error rates, and strengthen the overall claims process. • Collaborate with Customer Service leadership to identify training gaps and support the development of educational materials related to billing, coding, claim submission, and dispute processes for the CSRs. • Contribute to the development and maintenance of department policies, procedures, and job aids. • Maintain detailed, audit-ready case documentation for all disputes, adjustments, within Salesforce or the designated case management platform. • Ensure all dispute activity complies with applicable state and federal regulations, including ERISA requirements, state prompt-pay statutes, Texas Department of Insurance (TDI) rules, and internal policies. • Support internal and external audits by providing complete and organized dispute records, resolution documentation, and reporting as requested. • Stay current on regulatory changes affecting provider dispute resolution, claims payment requirement processes at both the federal and state level. • Adhere to all privacy, confidentiality, and data security requirements in the handling of provider and member information.

• Deliver exciting, age-appropriate activities like multi-sports, arts & crafts, group games, and creative play. • Set up engaging play spaces and keep things safe, clean, and awesome. • Supervise children with care and enthusiasm, ensuring every child feels welcome, safe, and included. • Prepare snacks and manage sign-in/out processes with a friendly face and attention to detail. • Work split shifts: 7:30–9:00am and 3:00–6:00pm, perfect for work-life balance or those seeking part-time fun! • Be a team player who can also take the lead when needed.

• Meeting with union members and their families • Explaining union benefits • Enrolling clients in additional programs that fit their needs.

• Meeting with union members and their families • Explaining union benefits • Enrolling clients in additional programs that fit their needs.