Job Details

PDR Intake Clerk

Job Type: Full-time - 100% Remote Position

Schedule: Monday -Friday 11:00am to 8:00pm EST/10:00am to 7:00pm CT

Pay: up to $14.00 per hour DOE

About the Role:

The PDR Intake Clerk is an entry-level, clerical role responsible for reviewing and entering provider dispute information into our claims system. This position focuses on accurate data entry, documentation review, and routing cases to the appropriate department for review.

This role is ideal for someone who is detail-oriented, comfortable working on a computer throughout the day, and able to follow structured processes.

Key Responsibilities

• Open and review incoming Provider Dispute Resolution (PDR) documentation
• Enter claim numbers into the DRT system to retrieve case details
• Review documentation to identify the reason for the dispute
• Select and update the appropriate Issue Code in the system
• Route (pend) cases to the appropriate department (MIU or UM) when required
• Ensure all required fields are completed accurately
• Maintain daily productivity and accuracy standards
• Follow HIPAA and company confidentiality guidelines

Required Qualifications

• High School Diploma or GED required
• Proficient with Microsoft Office (Word, Excel).
• Professional telephone manner.
• Strong data entry and filing skills.
• Excellent communication skills.
• Must be dependable and able to prioritize and accomplish work with minimal supervision.
• Strong customer service orientation to both internal and external customers.
• Basic computer skills required (typing, navigating multiple screens, data entry)
• Comfortable working in multiple systems at the same time
• Strong attention to detail
• Ability to follow step-by-step instructions and processes
• Reliable attendance and ability to meet daily production goals

Preferred (Not Required)

• Prior clerical or data entry experience
• Healthcare or claims experience
• Know Centers for Medicare and Medicaid Services(CMS) and Department of Managed Health Care (DMHC) timeliness requirement that pertain to AB1455 PDR Acknowledgment and resolution section.

Work Environment

• Production-based role with daily volume expectations
• Primarily computer-based work
• Limited phone interaction

***WORK FROM HOME REQUIREMENTS***

• High Speed Internet of 25MBPS download and 5MBPS upload. You will be required to provide a speed test.
• Ability to directly hardwire to your modem
• Required to have a quiet dedicated work area.

What We Offer:

• Paid training period
• Medical, Dental, Life, Vision, HSA, 401K
• 7 Paid Holidays with no wait time to qualify
• 6 PTO days (after 90 days)
• Equipment provided

Ready to Grow Your Career?

We'd love to meet you! Click "Apply Now" and tell us why you'd be a great addition to the Imagenet team.

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.