Claims Quality Specialist
Claims Quality Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
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
The Claims Quality Specialist is responsible for ensuring the accuracy and quality of claims processing within a managed care service organization. This role involves auditing claims identifying errors and implementing corrective actions to improve overall claims accuracy and efficiency. The Claims Quality Specialist will work closely with the Claims Research colleague and other team members to enhance claims processes and ensure compliance with regulatory standards.
Qualifications
Minimum Qualifications:
- Minimum of 5 years of experience in claims processing quality assurance or a related role within a managed care or healthcare environment.
- Strong knowledge of healthcare claims processing coding (ICD-10 CPT HCPCS) and billing practices
- Proficiency in using a managed care and/or claims processing platform.
- High School Diploma or equivalent required
Preferred Qualifications:
- Experience with data analytics tools and software such as SQL SAS
- Previous experience working directly with healthcare providers or within a provider network setting
- Bachelors Degree - Bachelors degree in Business Healthcare Administration or a related field
Required Experience:
Unclear Seniority
Employment Type
Unclear
