Claims Mailroom Examiner

Dignity Health Bakersfield , CA 93301

Posted 3 months ago

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

Responsible for the receiving, sorting, counting, batching, logging, storing, and distribution of all mail received in the Claims Department on a daily basis.

Qualifications

JOB KNOWLEDGE, SKILLS & ABILITIES

  • Familiarity with ICD-9, ICD-10, CP-4, HCPCS codes preferred.

  • Ability to operate a personal computer with knowledge of EXCEL and WORD programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Open all mail related to claims, date stamp, count, and sort according to departmental policies and procedures.

  • Identify claims with previous date stamp, misdirected claims, and non-contracted claims and distribute to Claim Examiner to process as priority mail.

  • Identify claims lacking health plan information and screen membership database for health plan assignment to sort claims appropriately.

  • Accurately sort claims according to the division of financial responsibility matrices and distribute as appropriate.

  • Adhere to organizational policies and procedures, attend meetings as required, and promote cooperation and understanding among peers.

  • Demonstrates effective "team" behavior by providing support assistance to fellow staff members in a courteous and professional manner.

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Claims Mailroom Examiner

Dignity Health