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Claims Processor Lead

Dignity Health Medical Group Rancho Cordova, California

The posted compensation range of $21.70 - $29.84 /hour is a reasonable estimate that extends from the lowest to the highest pay 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.

Requisition ID 2022-275972 Employment Type Full Time Department Claims Processing Hours/Pay Period 80 Shift Day Weekly Schedule Monday - Friday (8:00am - 5:00pm) Remote No Category Managed Care

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.

Under the general direction of the Manager the Lead will provide guidance training and subject matter expert level support for the claims staff. The Lead will have knowledge and ability to perform all Daily Operations that the Senior Claims staff is responsible for. The Lead position will provide coverage in the Managers absence including editing timecards in TEAM. This position will report directly to the Claims Manager. This position is the primary contact with Internal and External providers Health Plans Contract Department Hospital Capitation Claims Department Eligibility/Benefits Member Services Utilization Management Dignity Health Medical Foundation Patient Financial Services and AR billing. The position will work within the guidelines established by the departments Policy and Procedures and it has the responsibility for working independently and may be asked or assigned additional department job duties at the discretion of the manager. The Lead will support the Manager in organizing and distributing work assignments. This position will perform the duties of the Senior Claims Examiner when needed. These duties include compliance reporting to the health plans annual health plan audits appeals and PDRs recovery of overpayments and stop loss and support to the staff when needed. This position oversees staff including Senior Claims Examiners and is responsible for the quality review of daily work and reporting findings to the manager.

Minimum Qualifications: 
- Five (5) years as a senior claims examiner in all functional areas
- High School Diploma or equivalent (GED)
- Thorough knowledge of CPT ICD10 HCPCS Medical Terminology Industry standards of Compliance for State and Federal regulations
Preferred Qualifications: 
- Claims experience with Dignity Health Medical Foundation (DHMF)

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.