What are the responsibilities and job description for the Claims Manager position at Regal Medical Group?
Position Summary :
Claims processing from data entry to review of all claims prior to payment. Customer service. Medical Management Department support. They will be responsible to perform activities related to oversight of benefit analyst and system design , manage special projects , and auto -adjudication applications. This includes oversight of all workflow , research and documentation under limited supervision by by the Claims and Finance Management.
Essential Duties and Responsibilities include the following :
- Daily claims data entry / manual adjudication
- Daily review of claims status report
- Claims customer service
- Support UM department
- Verify eligibility and benefits
- Encounter data entry
- Verify claims received via fax
- Re-direct claims when necessary
- Claim review with verification of benefits
- Work directly with Northridge office for claims review and payment process
- Communicate with health plan regarding claim appeals
- Meet with Medical Director for claims review
- Review final claim payment EOB’s , copying and mailing
- Assist Executives with special projects
- Know location of Policy and Procedure and communication books and be familiar with contents
- All other duties as directed by management
- Employer-paid comprehensive medical, pharmacy, and dental for employees
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health Services
- 401k Retirement Savings Plan
- Income Protection Insurance
- Vacation Time
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- Mileage
The pay range for this position at commencement of employment is expected to be between $85,000 / year to $90,000 / year ; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and / or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department / team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits :
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness :
Savings and Retirement :
Other Benefits :
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Salary : $85,000 - $90,000
