The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a Claims Configuration Coordinator who will propose, monitor, develop, test and document claims as well as related procedural changes that are directed by state, federal and internal policy. The Claims Configuration Coordinator will communicate changes with HPSM staff and provider community, as well as provide support in the testing of all system enhancements and internal configuration updates to ensure accurate adjudication and adherence with state and federal guidelines. They will also resolve provider disputes, research, and resolve claim issues for providers and internal staff.
Research, analyze and recommend claims system configuration modifications. Develop and maintain updates of the all internal and external documentation related to Claims configuration and policy changes. Participate in provider education. Continually review/audit system configuration to ensure accurate application of policies. Keep abreast of healthcare industry best practices, system capabilities and managed care regulatory requirements. Coordinate and manage training associated with system changes. Review provider disputes.
Education and Experience - Five years work experience in a health care or managed care environment with an emphasis on coding and billing policy. Bachelor’s degree preferred. Coding Certificate preferred.
Knowledge of - Medical claims processes and procedures. Medicare and Medi-Cal programs. NCCI Edits.
Ability to - Communicate effectively, with a strong emphasis on written communication. Manage multiple projects simultaneously; prioritize/organize workload. Interpret government rules, regulations and guidelines. Use initiative; work independently; make sound independent judgments. Carry out multiple projects simultaneously. Proficiency in PC use including Excel and Word. Prepare concise reports and recommendations. Interact well with a variety of people, including ability to work effectively as part of a team across organizational structure.
BENEFITS: Excellent benefits package offered including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; 457 Plan in lieu of social security (7.5% of salary/HPSM paid); retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
APPLICATION PROCESS: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 701 Gateway Blvd., Suite 400, South San Francisco, CA94080. Email: email@example.com or Fax: (650) 616-8039 File by: Continuous until filled. EOE.
Located just south of San Francisco, HPSM is a non-profit health care plan that offers health coverage and a provider network to San MateoCounty’s underserved population. We currently serve approximately 100,000 county residents through the following programs: Medi-Cal, Healthy Kids, CareAdvantage (Medicare/Medi-Cal), San Mateo ACE/MCE, and HealthWorx.
Monster - 9 months ago