HealthSmart MSO, Inc. offers an excellent work environment and is looking for long- term team members to continue with our growth.
Come Join Our Team!
We have openings in the following Departments:
Claims Examiner:
Responsible for researching and processing Medical Claims for the various product lines, which includes: Medi-Cal, Healthy Families, Medicare, and Commercial. Process and adjust all claims timely, to ensure compliance with regulatory as well as departmental and company policies and procedures. Develop and maintain effective business relationships with internal and external clients. Must have Knowledge of medical terminology, ICD-9 and CPT coding and HCPC, read and interpret a DOFR (Division of Financial Responsibility), interact with Web Based Claims processing system/ Electronic claims processing, and posses some Microsoft Excel knowledge.
CREDENTIALING COORDINATOR:
Responsible for the Credentialing & Recredentialing of contracted providers networks in compliance with NCQA/DHCS and other regulatory requirements. Credentialing background preferred with experience in a hospital, healthplan or IPA/Medical Group. Strong PC and organizational skills. Micro-Med experience preferred. High level of attention to detail.
Case Management:
Responsible for telephonic concurrent review, discharge planning, and ambulatory case management. Active RN/LVN license and experience with hospital and/or managed care case management. The ideal candidate must prioritize multiple tasks and have good communication & Computer skills. Good growth opportunity for the right person.
UM Coordinator:
Responsible for daily authorization processing in the UM Department. MA with 2 years UM experience preferred. Knowledge of managed care, referral processing, benefit interpretation, eligibility verification, case coordination, medical terminology, ICD-9 and CPT coding required. Professional interaction with Medical Director(s)/Physicians Reviewer(s), IPA physicians and staff, Case Managers for outpatient case management identification, and other duties as assigned. Must be detail oriented, organized and a team player.
