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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: | $17.90 - $21.92 an hour. 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: |
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Position Qualifications and Requirements: |
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Education/Course(s) /Training: | High School Diploma required. |
Licensure/Certification: | N/A |
Location: | Mira Mesa, San Diego |
Date Posted: | September 21, 2023 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Claims |
Level: | Non-Supervisory |
Reports To: | Manager, Claims & Eligibility |
Private Health Information (PHI): | Position requires read and write access to member claims and read only access to member eligibility and authorizations. |
Job Classification: | Non-Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $21.66 - $26.53 an hour. Salary is based on qualifications and experience |
Position Summary: | These duties are split over four Auditor positions. Claims Auditors are responsible for the auditing of provider disputes, member denial letter requests, and daily prelag reports. Responsible for ensuring provider dispute and member denial letters are accurately handled. Responsible for notifying management of any compliance concerns with timeliness of claims payments. Reviewing and resolving HPIs and member OOP. |
Essential Job Functions: |
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Position Qualifications and Requirements: |
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Education/Course(s) /Training: | High School Diploma required. |
Licensure/Certification: | N/A |
Location: | Mira Mesa, San Diego |
Date Posted: | September 21, 2023 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Medical Management |
Level: | Non-supervisory |
Reports To: | Manager, Utilization Management |
Private Health Information (PHI): | Position requires "read and write" access to member authorizations, "read only" access to claims and eligibility |
Job Classification: | Non-Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $42.20 - $51.71 an hour. Salary is based on qualifications and experience |
Position Summary: | Reviews contracted Medical Group’s referral requests for medical necessity, determines which requests need Medical Director review, obtains sufficient medical documentation for an informed decision. Processes all requests within established timeframes. Documents all steps of process in authorization system, utilizes industry standard denial language for denial letters. |
Essential Job Functions: |
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Position Qualifications and Requirements: |
Experience/Specialized Skills: Prior experience in utilization management in a managed care environment. Proficient with computer, Microsoft Windows environment. |
Education/Course(s) /Training: | Registered Nurse |
Licensure/Certification: | Registered Nurse, active California License. |
Location: | Mira Mesa, San Diego |
Date Posted: | September 21, 2023 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Medical Management |
Level: | Non-supervisory |
Reports To: | Manager, Utilization Management |
Private Health Information (PHI): | Position requires "read and write" access to member authorizations, "read only" access to claims and eligibility |
Job Classification: | Non-Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $17.90 - $21.92 an hour. Salary is based on qualifications and experience |
Position Summary: | Performs data entry of referral requests. Contacts Health Plans for medical policies or benefit interpretations. Contacts physician offices to obtain additional clinical information. Monitors pended referral requests for turnaround time compliance. |
Essential Job Functions: |
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Position Qualifications and Requirements: | Experience/Specialized Skills: Knowledge of medical terminology, ICD and CPT coding. Proficient with computer, Microsoft Windows environment. |
Education/Course(s) /Training: | High School Diploma |
Licensure/Certification: | N/A |
Location: | Mira Mesa, San Diego |
Date Posted: | September 21, 2023 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |