Claims Processor Lead

Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California Arizona and Nevada. Today Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers we provide increasing support and investment in the latest technologies finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled qualities that are vital to maintaining excellence in care and service.

Under the general direction of management the Lead will provide guidance, training and subject matter expert level support for the claims staff. The Lead will have knowledge and ability to perform all Daily Operations that the Senior Claims staff is responsible for. This position will report directly to the Claims Supervisor. This position is the primary contact with Internal and External providers, Health Plans, Contract Department, Hospital Capitation Claims Department, Eligibility/Benefits, Member Services, Utilization Management, Dignity Health Medical Foundation Patient Financial Services and AR billing. The position will work within the guidelines established by the department's Policy and Procedures, and it has the responsibility for working independently and may be asked or assigned additional department job duties at the discretion of the manager. The Lead will support management in organizing and distributing work assignments. This position will perform the duties of the Senior Claims Examiner when needed. These duties include compliance reporting to the health plans, annual health plan audits, appeals and PDR's, recovery of overpayments and stop loss, and support to the staff when needed. This position oversees staff, including Senior Claims Examiners and is responsible for the quality review of daily work and reporting findings to the manager.

Minimum Qualifications:

• 5 years as a senior claims examiner in all functional areas
• High School Diploma or equivalent (GED)
• Thorough knowledge of CPT, ICD10, HCPCS, Medical Terminology, Industry standards of Compliance for State and Federal regulations

Preferred Qualifications:

• Preferred Licensure as certified coder but not required for the position
• Claims experience with IDX