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Career Opportunities

 


SOUTHERN CALIFORNIA PHYSICIANS MANAGED CARE SERVICES
CURRENT CAREER OPENINGS (As of January 22, 2019)


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:

Claims Assistant

Department: Claims and Eligibility
Level: Non-supervisory
Reports To: Claims and Eligibility Manager
Position's Access to Private Health Information (PHI): Position requires "read only" access to member authorizations and read and write access to member claims and eligibility
Job Classification: Non-Exempt
Job Type: Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate: Salary is based on qualifications and experience
Position Summary: Under the supervision of the Claims and Eligibility Manager, the Claims Assistant will prepare requested documents required by Claims & Compliance Manager for health plan audits. This role will be responsible for scanning and maintaining member denial letter documentation and scanning and maintaining all review documentation. Additionally, this role will assist the Claims Department as needed with various support duties vital to the functioning of the department and perform mailroom duties to process incoming and outgoing mail.
Essential Job Functions:
  • Prepares requested documents for health plan audits.
  • Perform mailroom duties, including matching & folding checks, folding letters, posting mail, sorting incoming mail, and maintaining the mail room.
  • Scan and maintain member denial letter documentation. Scan and maintain all review documentation related to the provider dispute resolution process.
  • Contact providers for additional information where indicated for developing unclean claims and provider disputes. Assist Claims Supervisor with data entry and the out of pocket maximum copayment process.
  • Monitor and distribute incoming faxes.
  • Compile subpoena and third-party liability requests for Claims Manager.
  • Assist Production staff with all mail room and store room duties as needed, including delivering and stocking copy paper to Medical Management, Network Management, and Finance.
  • Other duties as assigned.
  • Position Qualifications and Requirements:
  • Minimum two years clerical experience .
  • Must be able to work independently and have the ability to communicate and work with others to resolve issues.
  • Must have accuracy with numbers and be detail oriented. Must be organized and able to handle multiple tasks.
  • Must have experience in a Windows environment and be familiar with Microsoft Office.
  • Must type a minimum of 45 wpm.
  • High School Diploma or equivalent.
  • Location: Mira Mesa, San Diego
    Date Posted: January 22, 2019
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org


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    Credentialing Coordinator

    Department: Medical Management
    Level: Non-supervisory
    Reports To: Director, Medical Management
    Private Health Information (PHI): Position requires "read only" to member authorizations, claims and eligibility
    Job Classification: Non-Exempt
    Job Type: Full time - Four-Day 10 hour days, Monday - Thursday
    Pay Rate: Salary is based on qualifications and experience
    Position Summary: Under the supervision of the Director of Medical Management, the Credentialing Coordinator will be responsible for reviewing credentialing applications for completeness, completes primary source verification and prepares applications for committee review. Also, this role will be responsible for maintaining credentialing database on all credentialed providers.
    Essential Job Functions:
  • Reviews credentialing applications for completeness, and scans into database. Obtains current copies of medical license, DEA license and malpractice insurance and verifies with appropriate agency.
  • Complete primary source verification on all initial applicants and on all providers at time of re-credentialing within 180 days of application being signed..
  • Maintains credentialing database on all credentialed providers, updates information upon completion of re-credentialing, and as various documents expire.
  • Prepare credentialing packets for each Medical Group’s board meetings so review can be made within 180 days of application being signed.
  • Sends out initial credentialing packets to potential new providers, as directed. Sends out re-credentialing packets to providers 90 days prior to re-credentialing due date. Follows up with providers when applications are not returned timely.
  • Pulls credentialing files, reviews and prepares files for health plan delegation audits. Runs ad hoc reports from available databases.
  • Position Qualifications and Requirements:
  • Prior physician credentialing experience.
  • Proficient with computer, Microsoft windows environment.
  • Associate degree preferred.
  • Location: Mira Mesa, San Diego
    Date Posted: January 22, 2019
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org


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    Information Technology (IT) Department Assistant

    Department: Information Technology
    Level: Non-supervisory
    Reports To: Chief Information Officer
    Job Classification: Non-Exempt
    Job Type: Full time - Four-Day 10 hour days, Monday - Thursday
    Pay Rate: Salary is based on qualifications and experience
    Position Summary: Under the supervision Chief Information Officer, the IT Department Assistant will be responsible for assisting our Data management specialist with inbound and outbound (EDI) electronic data exchange. Also, this role will provide telephone training, registration and support for Web site users. Additionally, this role will perform administrative and clerical duties for the IT department and provide entry level hardware/software troubleshooting along with onboarding and offboarding of employees.
    Essential Job Functions:
  • Retrieve and distributes EDI data files from health plan websites and FTP
  • Submit outbound electronic medical claims to health plans and clearinghouses
  • Create user accounts for new SCPMCS employees on requested health plan web sites. Accurately update spreadsheet for Data management specialist who creates the Secure login function and trains the users
  • Provide Web site user support including password reset, new user profile setup, and new user telephone-based training
  • Perform administrative and clerical duties for the IT department
  • Manage printer supplies and repair requests
  • Participates in regular and temporary teams as assigned by the Director of Information Technology
  • Basic PC hardware/software troubleshooting
  • Assist with onboarding/offboarding of new employees
  • Perform other duties as assigned, including cross training and coverage of the IT Department
  • Position Qualifications and Requirements:
  • Proven ability to work with multiple projects with internal personnel and trading partners in a professional manner
  • Excellent interpersonal skills are essential
  • 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
  • Must be authorized to work in the USA
  • Must be able to speak/read/write English
  • Ability to compose letters with emphasis on correct grammar, punctuation, etc
  • Working knowledge of MS Office, Excel and Word, Access a plus
  • Experience in supporting IT is a plus
  • Location: Mira Mesa, San Diego
    Date Posted: January 22, 2019
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org


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    Production Assistant - Encounters

    Department: Claims and Eligibility
    Level: Non-supervisory
    Reports To: Production Supervisor
    Job Classification: Non-Exempt
    Job Type: Full time - Four-Day 10 hour days, Monday - Thursday
    Pay Rate: Salary is based on qualifications and experience
    Position Summary: Under the supervision of the Production Supervisor, the Production Assistant will be responsible for claims encounter reporting and review. This position will be responsible for encounters to health plans and clearinghouses. In addition, this position will research encounter rejects for correction, reviews claims to ensure all mandated data elements are present to ensure clean encounter submissions.
    Essential Job Functions:
  • Research and correct encounter reject online via clearinghouse and health plan portals.
    o Average of 60/day in combination of TransUnion portals
    o Complete all reject reviews/corrections for Office Ally, and direct submissions within 1 week from file submission
  • Review post inload reports to ensure all encounter required data elements are present. Make necessary corrections or notifies Claims Supervisor of any claims that need additional/corrected information .
  • Prepare encounter files for upload to clearinghouse and health plan(s) on a weekly basis. Maintain log of encounter files upload and total rejected.
  • Reconcile claim counts with clearinghouse/health plan acknowledgements of receipt.
  • Download clearinghouse and health plan encounter reports. Review for any potential issues in low submission rates or rejects.
  • Generate corrected encounter claims when necessary to correct eligibility, coding, or other rejection issues.
  • Back up Production Assistant and Claims Assistant positions as needed.
  • Position Qualifications and Requirements:
  • Two years of experience in managed care claims processing.
  • Must be proficient in claims terminology and knowledgeable of CPT, ICD-10 coding procedures.
  • Proficiency in Microsoft Access, Excel, and Word are required.
  • Proficiency in Windows 2000 and Computer Network file management required.
  • Ability to work independently and communicate effectively.
  • Detail oriented with ability to identify and resolve processing and procedure issues.
  • High School Diploma required.
  • Location: Mira Mesa, San Diego
    Date Posted: January 22, 2019
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org


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