Job description
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.
Responsibilities
Join our team as a Sr Claims Analyst and become an integral part of the Dignity Health Management Services Organization being a Subject Matter Expert for Claim Examiners and Leads for commercial, medicaid and medicare lines of business. Additionally, this role is responsible for review and approval of high dollar claims to include communication to Health Plans.
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. This is accomplished by entering/verifying claims data, and manually pricing claims as needed. Interface with our Utilization Management team to resolve authorization edits. Interface with our enrollment/eligibility team to resolve eligibility edits, interact with our configuration team to identify and resolve configuration edits, interact with our provider relations team to resolve provider claims/contract issues, interact with our disputes/appeals team to resolve claims disputes/appeals.
***This position is remote/work from home.
Qualifications
Minimum Qualifications:
Preferred Qualifications:
#DHMSOClaimsProcessing
Pay Range
$25.25 - $36.61 /hour
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
Join our team as a Sr Claims Analyst and become an integral part of the Dignity Health Management Services Organization being a Subject Matter Expert for Claim Examiners and Leads for commercial, medicaid and medicare lines of business. Additionally, this role is responsible for review and approval of high dollar claims to include communication to Health Plans.
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. This is accomplished by entering/verifying claims data, and manually pricing claims as needed. Interface with our Utilization Management team to resolve authorization edits. Interface with our enrollment/eligibility team to resolve eligibility edits, interact with our configuration team to identify and resolve configuration edits, interact with our provider relations team to resolve provider claims/contract issues, interact with our disputes/appeals team to resolve claims disputes/appeals.
***This position is remote/work from home.
Qualifications
Minimum Qualifications:
5-7 years of experience working in Claims.- Bachelor's degree in Healthcare Administration or related field, or equivalent industry experience in lieu of degree will be considered.
Preferred Qualifications:
Knowledge of ICD-9, 1CD-10, CPT-4, and HCPCS coding preferred.
- Experience with QNxt or Facets claims processing software
A compensation range of $45,000 to $75,000 is the reasonable estimate that 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.
#DHMSOClaimsProcessing
Pay Range
$25.25 - $36.61 /hour
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