Sr Claims Analyst
Dignity Health Management ServicesBakersfield, California
The posted compensation range of $25.25 - $36.61 /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 2023-305817 Employment Type Full Time Department Claims Processing Hours/Pay Period 80 Shift Day Weekly Schedule Monday - Friday (8:00am - 5:00pm) Remote Yes Category Managed Care
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.
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. Serve as a Subject Matter Expert for Claim Examiners and Leads. Responsible for review and approval of high dollar claims to include communication to Health Plans.
In addition, the Sr Claim Analyst will participate in Health Plan Audits, provide representation for DHMSO as a system and claim SME. Will be responsible to support the Claim team during system upgrades with preparing test plans, executing test plans and providing feedback to Upgrade team. Partner with Claim Manager and Director of Operations in review of Claim process improvement. Will provide historical and geographical guidance to ensure no disruption in service to Health Plans, Providers and internal partners.
8+ years working in a specific operational Claims environment; which would include a direct health plan, MSO and/or TPA
Associate’s Degree - Associate's degree in Healthcare Administration or related field, or equivalent industry experience in lieu of degree will be considered.
Ability to use the following general office equipment correctly and safely: desktop computer for data entry and typing, copy machine, scanner and facsimile machine, and of telephone equipment. Ability to be reliable in attendance and timeliness to work schedules. Ability to adhere to dress code, good grooming, and personal hygiene habits. Ability to maintain knowledge of and conform to company policies and procedures. Ability to maintain strict confidentiality at all times. Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities, demonstrating initiative for completing work assignments. Knowledge of arithmetic, including ability to add, subtract, multiply and divide whole and fractional numbers. Ability to read and comprehend written instructions and interpret numerical data. Good communication skills; able to read, write, and speak articulately, using established channels of communication.
- Knowledge of ICD-9, 1CD-10, CPT-4, and HCPCS coding preferred.
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,
pleaseclick here. (https://tbcdn.talentbrew.com/company/35300/img/v1_0/EEOC_KnowYourRightsEnglish.pdf)
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.
Dignity 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.