Job DescriptionPosition Summary:Provide daily supervision, leadership and coordination in the maintenance of Regal Medical Group's claims processing system. Supports accuracy of member benefit set up, assignments, claims processing, financial accuracy and data integrity.Essential Duties and Responsibilities include the following:
- Implements data integrity initiatives for all supporting system configuration including fee schedules, provider contracts, benefits, eligibility and any other areas that support the effective operation of internal systems.
- Communicates and implements programs within focused area of responsibility.
- Communicates, monitors and audits processes and procedures necessary to achieve strategic objectives.
- Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Regal Medical Group network.
- Develops and fosters a customer satisfaction focused, service mentality within department to strengthen and build relationships with Heritage Provider Network and other Regal Medical Group regions and departments and communicates a balanced view of Data Management importance in relation to other departments and business functions.
- Achieves successful delivery of data management deliverables meeting internal and external client needs
- Administers and ensures timely completion of all projects
- Reviews data management plans for content and structure
- Performs other duties as necessary
The pay range for this position at commencement of employment is expected to be between $23 - $25 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.Details of participation in these benefit plans will be provided if an employee receives an offer of employment.If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.Full Time Position Benefits:The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.Health and Wellness:
- Employer-paid comprehensive medical, pharmacy, and dental for employees
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health Services
Savings and Retirement:
- 401k Retirement Savings Plan
- Income Protection Insurance
Other Benefits:
- Vacation Time
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- Mileage
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.RequirementsEducation and/or Experience:
- 3-5 years of HMO Claims Adjudication experience (Professional Institutional)
- In depth knowledge of Health Care and HMO Benefit products and/or certification as it relates to the association to Health plan benefits
- In depth knowledge of Coding (CPT,HCPCS,ICD9,DRG)
- In-depth knowledge, experience and understanding of the managed care industry.
- Medical group or IPA preferred.
- 3-5 years of experience in management of Health Care processing systems.
- Excellent written and verbal communication skills.
- A bachelor's degree from a four-year college or appropriate industry experience and/or certification.