Managed Care Administrative Specialist, First 5 Yolo

2 weeks ago

Woodland, California, United States County of Yolo, CA Full time
Job Summary

We are seeking a highly skilled and detail-oriented Managed Care Administrative Specialist to join our team at First 5 Yolo. The successful candidate will be responsible for performing routine administrative and analytical work related to Managed Care billing, including fiscal administration and contract management, general and administrative support, and program analysis and compliance.

Key Responsibilities
  • Learn, understand, and carefully follow Managed Care billing and data policies and procedures
  • Regularly receive, review, and clean service and billing-related programmatic data
  • Verify client eligibility for managed care plan service coverage
  • Data transfers to third-party clearinghouse
  • Address any errors identified during the claiming process by working with billing agencies and Program Management staff to resolve errors
  • Reconcile payments received from Managed Care Plans and/or State MediCal for services rendered against claims submitted
  • Escalate any issues related to vendor relations, claims submission, and payment reconciliation to Management Staff, and monitor issues through to resolution
  • Monitor full revenue cycle for Managed Care and/or State MediCal billing (e.g., charge capture, claim generation, claim submission, remittance processing, third-party follow-up, etc.)
Requirements
  • High School Diploma or GED required (bachelor's degree preferred)
  • Three (3) years (5 years preferred) of general administrative or healthcare experience in a professional or technical capacity
  • Additional years of full-time education may be substituted for the required experience on a year-for-year basis up to a maximum of two years
  • Possession of valid California Driver's License and reliable transportation
Preferred Qualifications
  • Knowledge of MediCal billing and Electronic Medical Records preferred
  • Ability to accomplish tasks and meet deadlines independently
  • Communicate clearly and concisely, both orally and in writing
  • Receive, organize, analyze large datasets
  • Perform tasks with a high level of attention to detail and accuracy with minimal errors

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