Sr Claims Analyst
Company: Dignity Health Management Services
Location: Bakersfield
Posted on: January 27, 2023
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Job Description:
Overview:
The purpose of Dignity Health Management Services Organization
(Dignity Health MSO) is to build a system-wide integrated
physician-centric full-service management service organization
structure. We offer a menu of management and business services that
will leverage economies of scale across provider types and
geographies and will lead the effort in developing Dignity Health's
Medicaid population health care management pathways. Dignity Health
MSO is dedicated to providing quality managed care administrative
and clinical services to medical groups hospitals health plans and
employers with a business objective to excel in coordinating
patient care in a manner that supports containing costs while
continually improving quality of care and levels of service.
-Dignity Health MSO accomplishes this by capitalizing on
industry-leading technology and integrated administrative systems
powered by local human resources that put patient care
first.Dignity Health MSO offers an outstanding Total Rewards
package that integrates competitive pay with a state-of-the-art
flexible Health & Welfare benefits package. Our cafeteria-style
benefit program gives employees the ability to choose the benefits
they want from a variety of options including medical dental and
vision plans for the employee and their dependents Health Spending
Account (HSA) Life Insurance and Long Term Disability. We also
offer a 401k retirement plan with a generous employer-match. Other
benefits include Paid Time Off and Sick Leave.
Responsibilities:
Join our team as a Sr Claims Analyst and become an integral part of
the Dignity Health Management Services Organization being a Subject
Matter Expert for Claim Examiners and Leads for commercial,
medicaid and medicare lines of business. Additionally, this role is
responsible for review and approval of high dollar claims to
include communication to Health Plans. -The Senior Claims Analyst
is responsible for the accurate review, input and adjudication of
specialists, ancillary, and electronic claims in accordance with
outside regulations, internal production standards, and contractual
obligations of the organization. This is accomplished by
entering/verifying claims data, and manually pricing claims as
needed. Interface with our Utilization Management team to resolve
authorization edits. Interface with our enrollment/eligibility team
to resolve eligibility edits, interact with our configuration team
to identify and resolve configuration edits, interact with our
provider relations team to resolve provider claims/contract issues,
interact with our disputes/appeals team to resolve claims
disputes/appeals. - -***This position is remote/work from home.
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Qualifications:
Minimum Qualifications:- 5-7 years of experience working in Claims.
- Bachelor's degree in Healthcare Administration or related field,
or equivalent industry experience in lieu of degree will be
considered. -Preferred Qualifications:- Knowledge of ICD-9, 1CD-10,
CPT-4, and HCPCS coding preferred.- Experience with QNxt or Facets
claims processing software - -*A compensation range of $45,000 to
$75,000 is the reasonable estimate that CommonSpirit in good faith
believes it might pay for this particular job based on the
circumstances at the time of posting. CommonSpirit may ultimately
pay more or less than the posted range as permitted by law.While
you're busy impacting the healthcare industry, we'll take care of
you with benefits that include health/dental/vision, FSA, matching
retirement plans, paid vacation, adoption assistance, annual bonus
eligibility and more! -#DHMSOClaimsProcessing
Keywords: Dignity Health Management Services, Bakersfield , Sr Claims Analyst, Professions , Bakersfield, California
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