Dignity Health Provider Reimbursement Specialist in BAKERSFIELD, California

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

The Reimbursement Specialist maintains positive working relationships with network providers, key stakeholders, business units, departments and/or divisions within the assigned area, and will act as a primary contact (when assigned by Claims Leadership) for providers and/or others (i.e. Provider Relations, Contracting, Executives, etc.) on claims projects, complex claims and/or other non-routine claim issues.

Qualifications

  • BA/BS degree in Health Services, Health Care/Hospital Administration, a related field or any combination of education and experience providing equivalent background.

  • Minimum two years experience in claims review, processing, and/or appeals required.

  • Excellent oral and written communication skills to communicate with professionals and outside agencies.

  • Ability to deliver training and conduct meeting(s) to varied audiences.

  • In-depth product or multiple lines of business knowledge such as HMO, PPO, POS, etc.

  • Extensive knowledge of coding

  • Ability to translate policy and procedural information.

  • Ability to create and manage Corrective Action Plans associated with audit results and/or performance metrics.

  • Personal computer skills, knowledge of word processing/spreadsheet applications and billing software packages are preferred (i.e. NexGen, etc.).

  • Working knowledge of work flows

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Equal Opportunity

Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law. For more information about your EEO rights as an applicant, please

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 and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this telephone number.

Job ID 2018-54793

Employment Type Full Time

Department Claims Processing

Hours / Pay Period 80

Facility Dignity Health Management Services Organization

Shift Day

Location BAKERSFIELD

State/Province CA

Standard Hours Mon-Fri (8-5 PM)