Job Description
Job Description
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is eligible for remote work; Candidates MUST reside in California.
What You Will Be Doing :
Under general supervision, responsible for establishing and maintaining documentation related to current claims billing practices, and provider relationships in collaboration with Provider Services.
Essential Functions
- Monitors and research claims billing requirements for Medi-Cal and D-SNP
- Establish and maintain documentation related to claims billing requirements, including training materials, provider alerts, provider manual, and provider billing and resource webpage.
- Plans and facilitates regular meetings and communications with providers to provide information and training related to claims billing guidelines.
- Assist with provider onboarding, related to claim submission and billing guidelines.
- Limited to Moderate discretion and independent judgement.
What You Have :
Education and Experience
Required
Associate’s degree; andAt least four years in healthcare claims experience; andAt least two years provider engagement experienceAt least two years’ experience in Managed Medi-Cal / Medicaid and Medicare programs; orThe equivalent of experience and education combinedLicenses, Certifications
Required
Completion of a Coding Certification Program (credentialed through AAPC preferred)What You Bring :
Knowledge, Skills, Abilities and Competencies
In-depth knowledge of procedure coding, medical terminology, and their application to claims operations.In-depth knowledge of general medical benefits and exclusions.In-depth knowledge of regulatory guidelines related to Medi-Cal / Medicaid and Medicare claims billing.In-depth knowledge of provider and / or facility contract and payment structures, and reimbursement practices.Strong presentation skills, including but not limited to the ability to tailor presentations to a specific audience, and identify key messages.Strong listening skills, with the ability to accurately receive and understand inquires.Basic conflict resolution skills, including the ability to use tact and diplomacy to diffuse emotional situations.Basic problem-solving skills, including the ability to use identified data and information to solve problems.Strong understanding of the importance of the relationship between providers and the Plan.Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels inside and outside the organization.Strong oral and written communication skills, including the ability to communicate professionally to diverse individuals and groups inside and outside the organization.Strong collaboration skills, including but not limited to the ability to create and foster a collaborative work environment.Strong skills in Word, Excel, Outlook, and PowerPoint.Ability to work independently and as part of a team.Ability to treat confidential information with appropriate discretion.Ability to speak and be understood in English.Commitment to and ability to facilitate the adoption of the Plan’s strategy, vision, mission and values.Preferred
Produces work that is accurate and completeProduces the appropriate amount of workActively learns through experimentation when tackling new problems, using both successes and failures to learn.Rebounds from setbacks and adversity when facing difficult situations.Knows the most effective and efficient process to get things done, with a focus on continuous improvement.Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates their efforts on the more important priorities.What You Will Get : HPSJ Perks :
Competitive salaryRobust and affordable health / dental / vision with choices in providersGenerous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution planTwo flexible spending accounts (FSAs)Employer-Paid Term Life and AD&D InsuranceEmployer-Paid Disability InsuranceEmployer-Paid Life Assistance ProgramHealth AdvocacySupplemental medical, legal, identity theft protectionAccess to exclusive discount mallEducation and training reimbursement in addition to employer-paid elective learning courses.A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.A shorter commute – if you’re commuting from the Central Valley to the Bay Area.Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.We are an equal opportunity employer, and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
