Position has primary responsibility fro oversight of the claims audit functions, claims adjustment projects and health plan demands. Acts as a liaison between the MemorialCare Medical Foundation and contracted health plans fro all claim related audtis, DMHC audits, CMS audits and reporting/delegation audits. Responsible for maintaining claims policies and procedures.
Bachelor's degree in Business, Health Care Administration or related field or equivalent experience required.
Minimum 3-5 years supervisory experience or demonstrated leadership ability required.
Working knowledge of claims information systems.
Comprehensive knowledge of CPT, ICD-10, inpatient procedure coding, HCPC, Revenue codes, medical terminoloty and COB required.
Microsoft Excel, Work and Access skills preferred.
Detail oriented with excellent verbal and written communication skills.
Excellent critical thinking skills.
Ability to plan and identify opportunities to effectivey utilize resources.
Internal Number: MEM003286
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.
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