The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

What You Will Be Doing:

Under direct supervision, responsible for researching and resolving claims pended by HPSJ’s claim system to facilitate and complete successful, accurate and timely adjudication.

Must reside in California. Remote.

Essential Functions:

• Reviews claims data for accuracy and completeness.
• Researches and analyzes issues and errors to correctly identify cause.
• Approves or denies claims and sends required correspondence based on processing guidelines and production standards.
• Identifies error patterns and trends; documents and escalates.

What You Bring:

Required

• Ability to understand and apply moderately complex documents, and oral and written instructions.
• Ability to compare and discern the difference between multiple sets of data or information.
• Basic problem solving and analytical skills, including the ability to perform routine analysis and resolve problems using identified data and information.
• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, with ability to express self clearly and professionally, with appropriate grammar and spelling, and document according to standards.
• Ability to work independently and as part of a team.
• Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities.
• Can attend to a broader range of activities. Meets deadlines.
• Basic arithmetic skills.
• Basic skills in Windows, Excel, Word and Outlook.
• Ability to treat confidential information with appropriate discretion.
• Ability to speak and be understood in English.

Preferred

• Basic knowledge of and skills in automated claims processing systems.
• Basic knowledge of regulations governing Medi-Cal and/or managed care as they relate to claims.
• Basic knowledge of procedure coding and medical terminology, and their application in claims.
• Basic knowledge of general medical policy benefits and exclusions.
• Basic knowledge of industry standard payment practices.

What You Have:

Required

• High school diploma or general education degree; and
• At least two years of general clerical or data entry experience.

Preferred

• Claims or billing experience in healthcare, Medi-Cal and/or managed care.

What You Will Get:

HPSJ Perks:

• Competitive salary
• Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.