Job description
Overview
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.Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Responsibilities
Job Summary
Qualifications
Experience & Education
#DHMSOClaimsProcessing
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.Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Responsibilities
Job Summary
Responsible for the management of the Provider Dispute and Appeal process.- End to end ownership of the review assessment entry acknowledgement and processing of a provider dispute and member appeal.
- Ability to identify and articulate benefit contract and provider configuration issues.
Qualifications
Experience & Education
Minimum of 3 years experience processing online claims in a managed care environment.- Proficient knowledge of the reading of a CMS-1500 and UB-04 form.
- 3-5 years in member services or health data analysis experience preferably in managed care environment.
- Knowledge of health care delivery system Medicaid/Medicare related state programs and dual eligibility programs required.
- Strong working knowledge of concepts practices and procedures related to managed care / practice management.
- Established experience with database management system.
- Basic familiarity with Medical terminology is required.
- Computer skills to include Microsoft Word Excel and basic data entry including the ability to learn new and complex computer system applications.
- QNXT experience preferred.
- High School Diploma/GED - Requires an education level of at least a high school diploma or GED.
- A compensation range of $16.30/hour - $31/hour is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
#DHMSOClaimsProcessing
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