Claims Coordinator

CommonSpirit Health; Oxnard (CA); On-site; USD 42,000 - 65,000; Full time

Job summary

CommonSpirit Health is seeking a Claims Professional to ensure accurate and timely processing, submission, and resolution of healthcare claims for appropriate reimbursement.

You will review, code, and submit claims, investigate denials and rejections, and coordinate with stakeholders to maximize revenue recovery, applying knowledge of medical coding, payer regulations, and the revenue cycle with meticulous attention to detail.

Qualifications

• High School Graduate General Studies or Combination of education and work experience may be considered
• High School GED General Studies or Combination of education and work experience may be considered
• Bachelor's Degree in Healthcare Administration, Business, or related field, upon hire

Responsibilities

• Review, code, and submit claims
• Investigate denials and rejections
• Coordinate with stakeholders to ensure proper adjudication and maximize revenue recovery
• Maintain adherence to quality and production standards
• Ensure accurate processing and review of all claim documents

Education

High School Graduate General Studies

High School GED General Studies

Tools

Healthcare coding

Payer regulations

Job description

Job Summary and Responsibilities

As a Claims Professional, you will ensure accurate and timely processing, submission, and resolution of healthcare claims for appropriate reimbursement.

Every day you will review, code, and submit claims, investigate denials and rejections, and coordinate with stakeholders to ensure proper adjudication and maximize revenue recovery.

To be successful, you will demonstrate a comprehensive understanding of medical coding, payer regulations, and the revenue cycle, with keen attention to detail and strong analytical skills for complex claim resolution.

• Responsible for meeting all PHSO job standards described below
• Accurately review all incoming scanned claims to verify OCR verification is reading claim information correctly
• Maintain quality and production standards established by claims management
• Manage and process claims in a timely and accurate manner
• Ensure all claim documents are completed, processed and reviewed accurately
• Assist with claims inquiries, providing prompt and accurate responses

Job Requirements

Required

• High School Graduate General Studies or Combination of education and work experience may be considered
• High School GED General Studies or Combination of education and work experience may be considered

Preferred

• Bachelors Degree in Healthcare Administration, Business, or related field, upon hire

Where You'll Work

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.

One Community. One Mission. One California