Job Opening for Claims Lead in Desert Oasis Healthcare (Palm Desert, CA)

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Job Category : Management
Company Name: Desert Oasis Healthcare
Position Name: Claims Lead
Location : Palm Desert, CA
Job Description : To lead claims processing team for payment of all Primary Care Physician, hospital, ancillary, and specialist claims according to contract. Examine, enter and adjudicate professional and hospital claims in accordance with Managed Care Operations for accuracy, completeness, authorization, referrals, eligibility and benefits. Review claims being sent to UM review to ensure protocol is met. Review payment adjustments and refund requests. Ensure that team reviews bar code report with source documents, incorrect data is corrected as necessary. Research and resolve customer service issues in a timely manner to ensure quality claims service. Ensure daily self-audit reports are performed by the team. Participate in the reconciliation of Health Plan error reports. Assist claims management in training of team regarding contract application and disseminating info regarding adjudication policy and procedures. Responsible for assisting claim management in tracking team production, inventory accuracy and compliance to meet department goals. Demonstrate leadership and is responsible for portraying an example of excellence in every encounter. Provide feedback and reports concerns regarding deficiencies and issues requiring resolution to claims management. Assist with check run review. Perform other duties as assigned. (10544) High school diploma or equivalent required. Minimum of two years claims experience. Knowledge of Medicare rules, medical terminology, managed care health plan rules and regulations, ICD-6, CPT and RVS codes. Must be extremely computer literate. Strong organizational skills and the ability to work under pressure. Ability to communicate effectively. Able to multi-task and develop effective working relationships. No driving required.
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