Providence Health & Services Claims Examiner MSO in Mission Hills, California
Providence is calling a (Full Time/ Day Shift) Claims Examiner MSO at our Facey Sepulveda Annex location in Mission Hills, CA.
In this position you will:
- Be required in-depth understanding of managed care systems and the ability to utilize those concepts when processing claims. Effective communication skills and a working knowledge of managed care and provider contracts are critical as are good judgment and decision-making skills. Strong interpersonal relations and team building skills are a requirement for internal and external purposes. Experience in managed care and all aspects of professional, hospital and ancillary claims payment process is important. Supporting the values of PH&S-CA and proven ability to use team concepts to enhance shared leadership philosophies are essential for the success of this position. The Claims Examiner is responsible for processing claims. This position reports to the Manager, Claims - Management Services Organization.
Required qualifications for this position include:
Bachelor's degree in Health care administration, business administration or an equivalent area
Knowledge of and commitment to the application of Catholic/Christian health care ministries, principles and values.
Must have a working knowledge of health plan benefits, DOFR and claim payment guidelines, DMHC regulations, NCQA standards and medicare fee schedule and policies.
Skilled in investigating and researching specialized claims so that adjudication is accurate
Ability to read and interpret provider contracts and fee schedules
Must be proficient in the Claims module of the GE/IDX system
Ability to perform at high level in an environment of rapid growth, constant change and sometimes ambiguous circumstances
About the location you will serve:
Providence Health & Services Southern California is further developing its physician integration strategy. Historically, the largest asset has been Providence Medical Institute, a medical foundation that provides administrative and other support services to affiliated medical groups. Providence Medical Institute is expected to grow significantly in the next several years, bringing with it facilities, staff and physician growth to support that objective.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Claims
Location: California-Mission Hills
Req ID: 230965