Claims Examiner II - Dignity Health : Job Details

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 Under the guidance and supervision of the Manager of Claims, the Claims Examiner II is responsible for the efficient and accurate processing of healthcare claims. This role involves reviewing, analyzing, and adjudicating claims to ensure compliance with applicable policies, procedures, and regulations. The Claims Examiner II will handle complex cases, resolve discrepancies, and provide exceptional customer service to internal and external stakeholders. Qualifications Minimum Qualifications:

• Minimum of 2-4 years of experience in healthcare claims processing or a related field. Experience with managed care organizations (MCOs) or MSOs is highly desirable.
• Associate's Degree - Associate's degree in healthcare administration, business, or a related field. Equivalent work experience may be considered.

Preferred Qualifications:

• 4-5 years experience in healthcare claims processing or related field
• Proficiency in claims processing systems and software.
• Strong knowledge of CPT, ICD-10, and HCPCS coding.
• Excellent analytical and problem-solving skills.
• Attention to detail and accuracy.