Providence Health & Services Claims Examiner MSO in Mission Hills, California
Providence is calling a Claims Examiner MSO ( Full Time / Day Shift) to our Facey Sepulveda Annex location in Mission Hills, CA.
In this position you will:
Provide in-depth understanding of managed care systems and the ability to utilize those concepts when processing claims.
Effectively communication skills and a working knowledge of managed care and provider contracts. Critical judgment and good decision-making skills are needed.
Utilize strong interpersonal relations and team building skills for internal and external purposes.
Be responsible for providing professionalism in all aspects of managed care, hospital and ancillary claims payment process.
Support the values of Providence Health & Services-CA and its proven ability to use team concepts to enhance shared leadership philosophies.
Be responsible for processing claims.
Perform job activities in accordance with PH&S-CA Mission and Core Values, maintaining confidentiality while creating and maintaining a work environment that affirms and fosters respect for human diversity.
Required qualifications for this position include:
A bachelor’s degree in health care administration, business administration or an equivalent area. Equivalent work experience as a substitute to professional degree is acceptable.
A minimum of 3 years experience in claims processing is expected.
Must have a working knowledge of health plan benefits, DOFR and claim payment guidelines, DMHC regulations, NCQA standards and Medicare fee schedules 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.
Preferred qualifications for this position include:
- Work history emphasis within an independent physician association, management services organization or physician hospital organization is preferred.
About the organization you will serve:
Providence Health & Services 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: Administrative (Clinical)
Location: California-Mission Hills
Req ID: 207012