Health Plan Associate (Claims)
Reseda, CA Reseda, CA Full-time Full-time $22 - $25 an hour $22 - $25 an hour 7 hours ago 7 hours ago 7 hours ago , Seeking a Health Plan Associate (Claims) Keeping PACE with Today's Seniors! Growing Healthcare Organization, immediate direct hire opening! in Reseda, CA Salary Range $22 - $25/hour DOE We are seeking a Health Plan Associate with a focus in Claims to support our center in Reseda, CA.
This is a direct hire, full time position based in the Center.
WHAT type of company is this? Our PACE Program of All-Inclusive Care for the Elderly supports patients ages 55
that includes head-to-toe medical care, vibrant social centers, transportation services and compassionate home care in Reseda and the surrounding Valley.
PACE Centers are a safe and enjoyable place for Seniors to spend the day.
Participants can join in for a delicious meal, activities and friendship while visiting for appointments with doctors, nurses, and therapists.
WHEN? The Center Director will work Mon-Fri from 8:
30am-5pm.
WHY work here? Stability - organization has 100
years of wisdom & experience! Employee
Benefits:
Employer shares the majority of medical premium cost for you and your family PTO - In addition to your vacation time (up to 20 days), you accrue 1 hour of paid sick leave for every 30 hours worked Full-time employees (30
hours/week) will be paid holiday pay for 9 designated holidays 403b Plan - Tax Sheltered Annuity Savings Program (TSA) - You may place a percentage of your annual pre-tax salary into a choice of tax-deferred interest bearing retirement plans.
Each year that you contribute to the plan, your state and federal tax bills will be reduced.
Employer will match up to 3% of your annual salary into the TSA plan, based on the percentage you contribute.
Other Perks:
Annual Performance/Salary Review Promotional/Transfer Opportunities within organization and all locations Credit Union Employee Recognition Program ON-LINE TRAINING:
CEUs available for licensed staff.
WELLNESS PROGRAM:
Zumba classes, Yoga Classes, Yoga/Pilates, Fusion, Volleyball, Lunch n' Learn sessions o Kaiser Soundbites, Campus Walking Paths, Fitness Challenges/Biggest Winner Challenges Position Summary This position focuses 85-95% on Claims matters for the Center, and reports to the Health Plan Specialist.
Enter all administrative invoices into Oracle, research and respond to phone call, email and fax inquiries regarding invoice receipt and payment.
Research and verify claim status on the monthly IBNR.
Update or add new providers to PCO when needed.
Prepare manual checks for Executive Director's signature.
Record 820 DHCS payment detail on payment spreadsheet monthly.
Record Medicare payment detail on payment spreadsheet monthly.
Work pending claims weekly.
Clear SOC monthly with DHCS.
Provide monthly census to Peak and JHA Finance.
Research and take necessary action to resolve Medi-Cal eligibility issues.
Provide CareKinesis a Part A Stay Status report bi-monthly.
Prepare bi-annual Outcomes & Quality Measures report.
Review Capstone audits and schedule meetings with providers.
Order ID badges for participants and upload the photos to Peak's FTP site.
Research and resolve errors on RAPS return files.
Prepare incoming claims to be sent to Peak PACE Solutions.
Research statements received by participant to make sure providers have the correct insurance information in order to process claims for payment.
Research and provide requested information from law office Review in-center encounters to health plan vendor and create reports for submission.
Assist with providing relevant regulatory reporting.
Understands fiscal issues and is appropriately involved in meeting budget targets.
Consistently meets or exceeds Center target for productivity and customer service Education High school diploma required; Bachelor's degree preferred.
Certificates, licenses Must have a valid California driver's license.
TB screening and successful completion of a health examination by a health care provider is required for employment.
Experience Qualified Claims professional in the field of health plan claims management with demonstrated or potential competence in working with health plan management functions.
Knowledge of DHCS and Medi-Cal/CMS claims compliance.
Two (2) years plus of Claims experience.
Knowledgeable about senior health care.
PACE experience preferred Oracle preferred and or experience in PEAK TPA system preferred.
Some type of Claims software experience.
If you'd like to discuss this position and your career goals, click on our EZ Apply and a Sr.
Recruiter will schedule a brief call at your convenience!.
Estimated Salary: $20 to $28 per hour based on qualifications.
This is a direct hire, full time position based in the Center.
WHAT type of company is this? Our PACE Program of All-Inclusive Care for the Elderly supports patients ages 55
that includes head-to-toe medical care, vibrant social centers, transportation services and compassionate home care in Reseda and the surrounding Valley.
PACE Centers are a safe and enjoyable place for Seniors to spend the day.
Participants can join in for a delicious meal, activities and friendship while visiting for appointments with doctors, nurses, and therapists.
WHEN? The Center Director will work Mon-Fri from 8:
30am-5pm.
WHY work here? Stability - organization has 100
years of wisdom & experience! Employee
Benefits:
Employer shares the majority of medical premium cost for you and your family PTO - In addition to your vacation time (up to 20 days), you accrue 1 hour of paid sick leave for every 30 hours worked Full-time employees (30
hours/week) will be paid holiday pay for 9 designated holidays 403b Plan - Tax Sheltered Annuity Savings Program (TSA) - You may place a percentage of your annual pre-tax salary into a choice of tax-deferred interest bearing retirement plans.
Each year that you contribute to the plan, your state and federal tax bills will be reduced.
Employer will match up to 3% of your annual salary into the TSA plan, based on the percentage you contribute.
Other Perks:
Annual Performance/Salary Review Promotional/Transfer Opportunities within organization and all locations Credit Union Employee Recognition Program ON-LINE TRAINING:
CEUs available for licensed staff.
WELLNESS PROGRAM:
Zumba classes, Yoga Classes, Yoga/Pilates, Fusion, Volleyball, Lunch n' Learn sessions o Kaiser Soundbites, Campus Walking Paths, Fitness Challenges/Biggest Winner Challenges Position Summary This position focuses 85-95% on Claims matters for the Center, and reports to the Health Plan Specialist.
Enter all administrative invoices into Oracle, research and respond to phone call, email and fax inquiries regarding invoice receipt and payment.
Research and verify claim status on the monthly IBNR.
Update or add new providers to PCO when needed.
Prepare manual checks for Executive Director's signature.
Record 820 DHCS payment detail on payment spreadsheet monthly.
Record Medicare payment detail on payment spreadsheet monthly.
Work pending claims weekly.
Clear SOC monthly with DHCS.
Provide monthly census to Peak and JHA Finance.
Research and take necessary action to resolve Medi-Cal eligibility issues.
Provide CareKinesis a Part A Stay Status report bi-monthly.
Prepare bi-annual Outcomes & Quality Measures report.
Review Capstone audits and schedule meetings with providers.
Order ID badges for participants and upload the photos to Peak's FTP site.
Research and resolve errors on RAPS return files.
Prepare incoming claims to be sent to Peak PACE Solutions.
Research statements received by participant to make sure providers have the correct insurance information in order to process claims for payment.
Research and provide requested information from law office Review in-center encounters to health plan vendor and create reports for submission.
Assist with providing relevant regulatory reporting.
Understands fiscal issues and is appropriately involved in meeting budget targets.
Consistently meets or exceeds Center target for productivity and customer service Education High school diploma required; Bachelor's degree preferred.
Certificates, licenses Must have a valid California driver's license.
TB screening and successful completion of a health examination by a health care provider is required for employment.
Experience Qualified Claims professional in the field of health plan claims management with demonstrated or potential competence in working with health plan management functions.
Knowledge of DHCS and Medi-Cal/CMS claims compliance.
Two (2) years plus of Claims experience.
Knowledgeable about senior health care.
PACE experience preferred Oracle preferred and or experience in PEAK TPA system preferred.
Some type of Claims software experience.
If you'd like to discuss this position and your career goals, click on our EZ Apply and a Sr.
Recruiter will schedule a brief call at your convenience!.
Estimated Salary: $20 to $28 per hour based on qualifications.
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