Claims Processor Lead

Title: Claims Processor Lead

Location: Rancho Cordova, California United States

Job Description:

 

The posted compensation range of $23.00 - $32.66 /hour is a reasonable estimate that extends from the lowest to the highest pay 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.

Requisition ID 2025-393989

Employment Type Full Time

Department Claims Processing

Hours/Pay Period 80

Shift Day

Weekly Schedule Monday - Friday (8:00am - 5:00pm)

Category  Managed Care

Overview

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.

Responsibilities

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.

Qualifications

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

***This position is remote. Candidate will be required to attend trainings and meetings at the Rancho Cordova, CA office. 

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible employees may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.