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Career Opportunities

 


SOUTHERN CALIFORNIA PHYSICIANS MANAGED CARE SERVICES
CURRENT CAREER OPENINGS (As of 12/03/2018)


Southern California Physicians Managed Care Services is San Diego's premier provider of medical administrative services including claims payment, contracting and utilization management.

Current Career Opportunities:

Southern California Physicians Managed Care Services has the following career opportunities available:

Information Technology (IT) Department Assistant

Job Description: Responsible for assisting the Data Management Specialist with inbound and outbound (EDI) electronic data exchange. Provides telephone training, registration and support for Web site users. Perform administrative and clerical duties for the IT department. Provide entry level hardware/software troubleshooting along with onboarding and offboarding of employees.
Skills/Requirements:
  • Proven experience supporting multiple electronic environments for data exchange with trading partners in both batch and interactive environments including the Web and FTP.
  • Should be familiar with and have experience with EDI formats, multiple protocols, preferably in a medical transaction environment. Working knowledge of MS Office, Excel and Word, Access a plus.
  • Proven ability to work with multiple projects with internal personnel and trading partners in a professional manner.
  • Excellent interpersonal skills are essential.
  • Must be able to occasionally work evenings and weekends as needed.
  • Proven organizational skills with attention to detail and the ability to prioritize work.
  • Strong written and verbal communication skills.
  • Must have an excellent disposition/attitude and ability to multi-task.
  • Experience in supporting IT is a plus.
  • Must be able to speak/read/write English.
  • Ability to compose letters with emphasis on correct grammar, punctuation, etc.
  • Pay Rate: Salary is based on qualifications and experience
    Job Status: Full time - Four-Day 10 hour days, Monday - Thursday
    Location: Mira Mesa, San Diego
    Date Posted: 12/03/2018


    Claims Compliance Manager

    Job Description: Primary duties of this position is to prepare for Health Plan claims audits; prepare monthly and quarterly claim reports, monitor claims payment to ensure that each line of business operates within State and Federal regulations, and Health Plans’ policies and procedures.
    Skills/Requirements:
  • 5 years’ experience with Manager Healthcare or HMO setting.
  • Thorough understanding of claims compliance regulations for CMS and the California Department of Managed Health Care.
  • Proven experience with health plan audits required.
  • Proficiency in Microsoft Office software.
  • Pay Rate: Salary is based on qualifications and experience
    Job Status: Full time - Four-Day 10 hour days, Monday - Thursday
    Location: Mira Mesa, San Diego
    Date Posted: 12/03/2018


    Claims Production Assistant

    Job Description: Prepares claims encounter data for submission to clearinghouses and health plans by generating filters, downloading data and prepping raw files. Maintains claims encounter logs and reconciles with clearinghouse/health plan responses. Researches and corrects rejects. Provides back up to ‘Production Assistant – Claims’, to include inbound claim file management and reject processing.
    Skills/Requirements: The preferred candidate will have previous experience in claims processing, proficiency in Microsoft Access, Excel, and Word, and file management. Qualified candidates must be detail oriented and be able to work well independently and in a team. Must be a quick learner with the ability to adapt quickly to the changing demands of the position.
    Pay Rate: Salary is based on qualifications and experience
    Job Status: Full time - Four-Day 10 hour days, Monday - Thursday
    Location: Mira Mesa, San Diego
    Date Posted: 12/03/2018


    CLIENT SERVICES REPRESENTATIVE - Bilingual English/Spanish

    Job Description: The Client Services Representative provides internal and external clients with information related to managed care services; such as Utilization Management, Claims Processing, IPA Management, Eligibility and Contracting.
    Skills/Requirements: This position requires two years experience in a health care setting. Additional requirements include claims/billing experience, knowledge of managed care, CPT, ICD-10 codes, and excellent verbal communication skills. Familiarity with Microsoft Office products.
    Pay Rate: Salary is based on experience, qualifications and internal equity.
    Job Status: Full time (7:00 a.m. – 5:30 p.m.), Monday - Thursday
    Location: Mira Mesa, San Diego
    Date Posted: 12/03/2018


    Outpatient Case Manager (RN)

    Job Description: Outpatient Case Manager reviews contracted Medical Group’s authorization requests for medical necessity.
    Skills/Requirements: This position requires prior experience in managed care or recent acute care. Computer proficient with MS Office. Other requirements include an active unrestricted California RN License.
    Pay Rate: Salary is based on qualifications and experience
    Job Status: Full time - Four-Day 10 hour days, Monday - Thursday
    Location: Mira Mesa, San Diego
    Date Posted: 12/03/2018