COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

POSITION OVERVIEW

The Provider Service Coordinator is responsible for supporting the provider network by investigating, analyzing, and resolving claim-related issues. This role manages the intake, review, tracking, and distribution of provider disputes and appeals, ensuring timely and accurate resolution in alignment with CMS, and organizational requirements. The Provider Services Coordinator serves as a key liaison between providers, internal departments, and leadership to ensure high-quality service and strong provider relationships.

Key Responsibilities

Claims Investigation & Resolution

• Handle provider inquiries timely and effectively, documenting discussions, issues, and action items in Salesforce.
• Research claim issues and route to the appropriate staff for resolution.
• Conduct detailed investigations of provider claim issues, including denials, payment discrepancies, coding concerns, and processing errors.
• Collaborate with Claims Operations, Configuration, Utilization Management, Grievance & Appeals and other internal teams to determine root causes.
• Analyze claims data to identify trends and recurring issues; escalate systemic concerns to leadership.
• Ensure responses and adjustments comply with organizational policies and regulatory requirements.
• Assist in strategic projects to help improve efficiencies.

Provider Disputes & Appeals Management

• Receive, log, and track provider disputes and appeals in accordance with CMS and department processes.
• Review supporting documentation and determine the appropriate handling path.
• Communicate determinations to providers clearly and professionally within required timeframes.
• Maintain documentation and audit-ready records for all dispute and appeal activities in Salesforce.

Provider Support & Communication

• Serve as a point of contact for providers seeking updates on cases related to claims, and provider disputes.
• Assist in preparing reports, dashboards, and summaries of dispute/appeal activity.

Qualifications

Required

• 2+ years of experience in claims processing, provider services, appeals/disputes, or health plan operations.
• Understanding of medical claims, coding (ICD 10, CPT, HCPCS), payment methodologies, and managed care processes.
• Experience working with providers, health plans, or medical billing entities.
• Excellent analytical, problem-solving, and investigative skills.
• Strong written and verbal communication skills; ability to convey complex topics clearly.
• Excellent customer service skills.
• Must have the ability to work independently and within a team environment.
• Ability to multitask.

Preferred

• Experience with Medicare Advantage and/or CSNP programs.
• Knowledge of CMS regulations related to provider appeals and grievances.
• Familiarity with claims platforms (Salesforce, Health Rules Payers).
• Proficient in Microsoft Office applications, preferably advanced in Excel.

Zing Health offers the following benefits:

• A competitive salary based on the market

• Medical, Dental, and Vision

• Paid-Time-Off

• Employee Assistance Programs

• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness 

coverage, ID Protection, etc.

 6-Month Assignment Specifics 

• The tasks are very repetitive
• Making progress to reduce the backlog is critical to being successful in this role
• Available to work 8:30 am - 5:00 pm CST (may be flexible with hours, but 75% of work time must be between these hours)

Zing Health is committed to being an Equal Opportunity Employer. This means the company ensures all employment decisions, including hiring, promotion, compensation, and benefits, are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected characteristic. Zing Health strives to create a diverse, inclusive, and respectful workplace, providing equal access and opportunities for all employees and applicants. The organization actively promotes a culture of fairness and non-discrimination, supporting the personal and professional growth of every team member