Dignity Health

  • Provider Reimbursement Specialist

    Job ID
    2018-54793
    Employment Type
    Full Time
    Department
    Claims Processing
    Hours / Pay Period
    80
    Facility
    Dignity Health Management Services Organization
    Shift
    Day
    Location
    Bakersfield
    State/Province
    CA
    Standard Hours
    Mon-Fri (8-5 PM)
    Work Schedule
    8 Hour
  • 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

    The Reimbursement Specialist maintains positive working relationships with network providers, key stakeholders, business units, departments and/or divisions within the assigned area, and will act as a primary contact (when assigned by Claims Leadership) for providers and/or others (i.e. Provider Relations, Contracting, Executives, etc.) on claims projects, complex claims and/or other non-routine claim issues. 

    Qualifications

    • BA/BS degree in Health Services, Health Care/Hospital Administration, a related field or any combination of education and experience providing equivalent background.
    • Minimum two years experience in claims review, processing, and/or appeals required.
    • Excellent oral and written communication skills to communicate with professionals and outside agencies.
    • Ability to deliver training and conduct meeting(s) to varied audiences.
    • In-depth product or multiple lines of business knowledge such as HMO, PPO, POS, etc.
    • Extensive knowledge of coding
    • Ability to translate policy and procedural information.
    • Ability to create and manage Corrective Action Plans associated with audit results and/or performance metrics.
    • Personal computer skills, knowledge of word processing/spreadsheet applications and billing software packages are preferred (i.e. NexGen, etc.).
    • Working knowledge of work flows

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