Claims Resolution Specialist & Provider Training

Partnership HealthPlan of California; California (MO); On-site; USD 50,971 - 64,747; Full time

Job summary

Partnership HealthPlan of California seeks a claims analysis professional to research and resolve complex provider inquiries across departments, while developing training materials for providers across lines of business. The role includes conducting trainings, updating the PR Manual, and producing quarterly reports on provider trends and outcomes.

The position requires familiarity with Medi-Cal, CPT/HCPC/ICD-9 coding, and strong data reporting capabilities.

Qualifications

• Familiarity with Medi-Cal and/or managed care claims processing.
• Knowledge of CPT, HCPC procedure coding, and ICD-9 diagnostic coding.
• Typing speed 30 wpm and proficient use of 10-key calculator.
• Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy.

Responsibilities

• Answers customer service lines as necessary and responds to provider inquiries about claims by phone, email, or in person.
• Reviews, researches and collaborates with departments to resolve complex provider inquiries, appeals, and grievances.
• Acts as a resource to customer service and Provider Relations staff for complex provider questions regarding claims and payments.
• Coordinates with Claims, Member Services, Health Services to develop, maintain, and train provider materials for the PR Manual and PHC website.

Skills

Medi-Cal familiarity

Managed care claims processing

CPT/HCPC/ICD-9 coding

Typing 30 wpm

10-key calculator

California driver’s license

Auto/insurance proof

Job description

Partnership HealthPlan of California seeks a claims analysis professional to research and resolve complex provider inquiries across departments, while developing training materials for providers across lines of business. The role includes conducting trainings, updating the PR Manual, and producing quarterly reports on provider trends and outcomes.

The position requires familiarity with Medi-Cal, CPT/HCPC/ICD-9 coding, and strong data reporting capabilities.