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Career Opportunities

 


SOUTHERN CALIFORNIA PHYSICIANS MANAGED CARE SERVICES
CURRENT CAREER OPENINGS (As of June 29, 2022)


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:

Client Services Representative (Bilingual English/Spanish)

Department: Network Management
Level: Non-supervisory
Reports To: Director, Network Management
Private Health Information (PHI): Position requires "read only" access to member authorizations, claims and eligibility. "Write" access to member notes only.
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: Provides internal and external clients with information related to managed care services; such as Utilization Management, Claims Processing, IPA Management, Eligibility and Contracting.
Essential Job Functions:
  • Initiates and coordinates resolution of inquiries from both internal and external clients.
  • Obtains appropriate data to research issues, including but not limited to medical records, claim/authorizations copies and other contributing information.
  • Provides clients with immediate status of authorizations, claims processed, eligibility, physician availability and demographic information.
  • Processes and researches client issues via EZCAP System. Enters member notes on all issues requiring additional action.
  • Responds to clients via phone, e-mail, fax or letter on issues that cannot be resolved during the course of the initial phone contact.
  • Cross-trains into other Network Management positions as needed, performs other duties as assigned.
  • Position Qualifications and Requirements:
  • Two years experience in a healthcare setting
  • One year experience working in a customer service/call center environment
  • Ability to answer a minimum of 70 calls per day
  • Ability to type a minimum of 40 wpm
  • Excellent communications skills
  • Basic knowledge of Microsoft Office Products
  • Knowledge of CPT, ICD-10 codes desired
  • Knowledge of basic managed care principles and processes desired
  • Bilingual a plus
  • Education/Course(s) /Training: High School Diploma
    Licensure/Certification: NA
    Location: Mira Mesa, San Diego
    Date Posted: June 29, 2022
    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) / Claims Assistant

    Department: Information Technology / Claims
    Level: Non-supervisory
    Reports To: Production & Eligibility Manager
    Private Health Information (PHI): Position requires "read only" access 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: IT - 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.

    Claims - Assists the Claims Department staff by sorting & distributing daily forms and letters, pulling manual claims, and distributing incoming faxes. Handles mail room functions, including sorting and posting mail, scanning, and folding letters, and forwarding misdirected claims. Assists with pulling claims for audits.
    Essential Job Functions: IT Responsibilities:
  • Retrieves and distributes EDI data files from health plan websites and FTP.
  • Submits outbound electronic medical claims to health plans and clearinghouses.
  • Creates user accounts for new SCPMCS employees on requested health plan websites. Accurately update spreadsheet for Data Management Specialist who creates the Secure login function and trains the users.
  • Provides Web site user support including password reset, new user profile setup, and new user telephone-based training
  • Reports all security, privacy, and procedure breaches to the Director of Information Technology immediately.
  • Manage printer supplies and repair requests.
  • Performs other duties as assigned, including regular and temporary teams as assigned by the Director of Information Technology.
  • Basic PC hardware/software troubleshooting.
  • Assist with onboarding/offboarding of new employees.

  • Claims Responsibilities:
  • Prepares requested documents for health plan audits.
  • Sorts and operates folding machine for all outgoing letters and checks.
  • Compiles misdirected claims. Prints misdirected claims and mails them to appropriate health plan.
  • Applies postage to all outgoing mail.
  • Sorts and distributes incoming mail.
  • Distributes incoming fax emails.
  • Keeps mailroom clean and stocked. Refills the copier and fax machine with paper as required.
  • Other duties as assigned.
  • Position Qualifications and 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.
  • 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.
  • Must be able to occasionally work evenings and weekends as needed.
  • Minimum two years clerical experience.
  • Ability to compose letters with emphasis on correct grammar, punctuation, etc.
  • Experience in supporting IT is a plus.
  • Education/Course(s) /Training: Associate degree in Information Systems or Business Administration or equivalent experience required, Bachelor's preferred.
    Licensure/Certification: N/A
    Location: Mira Mesa, San Diego
    Date Posted: June 29, 2022
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org


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