Claims Processor Lead
Company: CommonSpirit Health
Location: Rancho Cordova
Posted on: May 24, 2023
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Job Description:
Overview
Dignity Health Medical Foundation established in 1993 is a
California nonprofit public benefit corporation with care centers
throughout California. Dignity Health Medical Foundation is an
affiliate of Dignity Health - one of the largest health systems in
the nation - with hospitals and care centers in California Arizona
and Nevada. Today Dignity Health Medical Foundation works
hand-in-hand with physicians and providers throughout California to
provide comprehensive health care services to the many communities
we serve. As Dignity Health Medical Foundation continues to grow
and establish new premier care centers we provide increasing
support and investment in the latest technologies finest physicians
and state-of-the-art medical facilities. We strive to create
purposeful work settings where staff can provide great care while
advancing in knowledge and experience through challenging work
assignments and stimulating relationships. Our staff is
well-trained and highly skilled qualities that are vital to
maintaining excellence in care and service.
Responsibilities
Under the general direction of the Manager the Lead will provide
guidance training and subject matter expert level support for the
claims staff. The Lead will have knowledge and ability to perform
all Daily Operations that the Senior Claims staff is responsible
for. The Lead position will provide coverage in the Managers
absence including editing timecards in TEAM. This position will
report directly to the Claims Manager. This position is the primary
contact with Internal and External providers Health Plans Contract
Department Hospital Capitation Claims Department
Eligibility/Benefits Member Services Utilization Management Dignity
Health Medical Foundation Patient Financial Services and AR
billing. The position will work within the guidelines established
by the departments Policy and Procedures and it has the
responsibility for working independently and may be asked or
assigned additional department job duties at the discretion of the
manager. The Lead will support the Manager in organizing and
distributing work assignments. This position will perform the
duties of the Senior Claims Examiner when needed. These duties
include compliance reporting to the health plans annual health plan
audits appeals and PDRs recovery of overpayments and stop loss and
support to the staff when needed. This position oversees staff
including Senior Claims Examiners and is responsible for the
quality review of daily work and reporting findings to the
manager.
Qualifications
Minimum Qualifications:
- Five (5) years as a senior claims examiner in all functional
areas
- High School Diploma or equivalent (GED)
- Thorough knowledge of CPT ICD10 HCPCS Medical Terminology
Industry standards of Compliance for State and Federal
regulations
Preferred Qualifications:
- Claims experience with IDX
***This position is remote/work from home. The candidate will be
required to come into the Rancho Cordova, CA office for trainings
and meetings.
Keywords: CommonSpirit Health, Rancho Cordova , Claims Processor Lead, Other , Rancho Cordova, California
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