Job Location Main Office - Santa Barbara, CA 93110 Position Type Full Time Salary Range $23.00 - $32.00 Hourly
Job Category Claims
Central Coast Salary Range - $23.30/hour - $32.62/hour
This position is responsible for: researching, correcting and responding to all D-SNP pended claims as well the review of Audit reports in a timely manner; determining whether a claim should be paid (in accordance with the policies and procedures) and maintaining correspondence for document procedure /medical/CPT/ HCFA codes; assuring all regulatory guidelines are being followed.
Duties and Responsibilities
Review, price and release claims associated with the assigned claim types (paper and electronic)
Review Manual Review reports that suspend for review for D-SNP claims
Keep up to date on all D-SNP policies and provide materials for improvement projects within Department
Assure all regulatory guidelines are being followed and monitored
Maintain daily activity log
Assist with the processing of claims
Other duties and projects assigned
Knowledge/Skills/Abilities
QNXT experience
Strong knowledge of the D-SNP program
Strong knowledge in dual eligible claims processing (Medi-Cal and Medicare D-SNP )
Prior experience in high volume production environment
Good oral and written communication skills
Attention to detail
Medical terminology and/or coding experience is highly desirable
Education and Experience
Required:
High school diploma or equivalent
Three (3) years’ experience as a Claims Examiner
Serving the community since 1983, CenCal Health provides comprehensive health coverage to 1 in 3 residents of Santa Barbara County and 1 in 4 residents of San Luis Obispo County, enrolled in Medi-Cal. This regional health plan partners with over 1,500 local physicians and other providers to deliver quality patient care. CenCal Health also collaborates with community-based organizations to address social determinants of health while increasing members’ access to medical care and reducing costs. The oldest Medicaid managed care plan of its kind, CenCal Health is a not-for-profit agency that employs nearly 400 people at offices in both Santa Barbara and San Luis Obispo. For more information, visit cencalhealth.org.
