Claims Examiner III

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

The Claims Examiner III is an advanced-level role responsible for the detailed and accurate processing, review, and adjudication of complex healthcare claims. This position requires expert knowledge of

claims processing, coding, and regulatory compliance. The Claims Examiner III will handle the most challenging cases, mentor junior staff, and contribute to the development of policies and procedures.

Qualifications

Minimum Qualifications:

• 3-5 years of experience in healthcare claims processing, with at least 2 years in a senior or advanced role
• Expert knowledge of CPT, ICD-10, HCPCS coding, and medical terminology.
• Associate’s Degree - Associate’s Degree in healthcare administration, business, or related field preference.
• CPC

Preferred Qualifications:

• 5-7 years of experience in healthcare claims processing, with at least 4 years in a senior or advanced role
• EZCAP: 2 year experience
• Bachelor’s degree in healthcare administration, business, or a related field preferred. Equivalent work experience will be considered.
• Certified Medical Reimbursement Specialist (CMRS), or similar certification is preferred.