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Sr Claims Examiner

Dignity Health Medical Group Rancho Cordova, California
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The posted compensation range of $19.73 - $27.13 /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 2022-275971 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
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 departments 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:

  • Five 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.
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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.