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Sr Claims Examiner

3 months ago

Rancho Cordova, California, United States Dignity Health Full time

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

The Senior Claims Examiner responsibilities include Quality Review of Claims Examiners daily claims processing Data Entry daily claims processing and the accuracy of member denial Letters. The Senior Claims Examiner reviews all provider payment inquiries received by telephone fax and mail and adjust claim payments when required. This includes Commercial and Medicare Provider Dispute Resolutions (PDR). This position is responsible for the recovery of claim overpayments and repayments associated with contractual agreements through the stop loss carrier third party liabilities health plan indemnified services and the Western Health Advantage `Advantage Referral Program'. This position has the responsibility of the preparation of all Health Plan audits and the monthly compliance reporting (MTR) for claims and PDR timeliness. Provider weekly check runs are included under the Senior Claims Examiner's responsibilities. It is an expectation of the Senior Examiner to provide training to the data entry and claims examiners and ongoing support and guidance. This position has contact with Internal and External providers Health Plans Contract Department Hospital Capitation Claims Department Eligibility Member Services UM and any other applicable staff. The position has the freedom to work within the guidelines established by the department's Policy and Procedures has the responsibility for working independently and may be asked or assigned additional department job duties at the discretion of the manager.

Qualifications

Minimum Qualifications:

  • Three years experience in a Managed Care insurance environment preferably claims examiner experience.
  • High School Diploma or equivalent certificate.
  • Keyboarding skills and the ability to utilize computer equipment and software are required as is experience with other types of standard office equipment. Forty-five (45) wpm and 10 key by touch required.
  • Knowledge of Micrsoft office products specifically Excel and Word.

Preferred Qualifications:

  • Familiarity with an electronic practice management system is preferred. Medical terminology preferred.

Pay Range

$ $30.22 /hour

We are an equal opportunity/affirmative action employer.