Health Plan of San Joaquin/Mountain Valley Health Plan · 9 hours ago
Provider Billing and Resource Specialist
French Camp, CA
Full-time
Remote
Mid Level
$54K/yr - $70K/yr
4+ years exp
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Responsibilities
Monitors and research claims billing requirements for Medi-Cal and D-SNP
Establish and maintain documentation related to claims billing requirements, including training materials, provider alerts, provider manual, and provider billing and resource webpage.
Plans and facilitates regular meetings and communications with providers to provide information and training related to claims billing guidelines.
Assist with provider onboarding, related to claim submission and billing guidelines.
Limited to Moderate discretion and independent judgement.
Qualification
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Required
Associate’s degree;
At least four years in healthcare claims experience;
At least two years provider engagement experience
At least two years’ experience in Managed Medi-Cal/Medicaid and Medicare programs;
Completion of a Coding Certification Program (credentialed through AAPC preferred)
In-depth knowledge of procedure coding, medical terminology, and their application to claims operations.
In-depth knowledge of general medical benefits and exclusions.
In-depth knowledge of regulatory guidelines related to Medi-Cal/Medicaid and Medicare claims billing.
In-depth knowledge of provider and/or facility contract and payment structures, and reimbursement practices.
Strong presentation skills, including but not limited to the ability to tailor presentations to a specific audience, and identify key messages.
Strong listening skills, with the ability to accurately receive and understand inquiries.
Basic conflict resolution skills, including the ability to use tact and diplomacy to diffuse emotional situations.
Basic problem-solving skills, including the ability to use identified data and information to solve problems.
Strong understanding of the importance of the relationship between providers and the Plan.
Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels inside and outside the organization.
Strong oral and written communication skills, including the ability to communicate professionally to diverse individuals and groups inside and outside the organization.
Strong collaboration skills, including but not limited to the ability to create and foster a collaborative work environment.
Strong skills in Word, Excel, Outlook, and PowerPoint.
Ability to work independently and as part of a team.
Ability to treat confidential information with appropriate discretion.
Ability to speak and be understood in English.
Commitment to and ability to facilitate the adoption of the Plan’s strategy, vision, mission and values.
Preferred
Produces work that is accurate and complete
Produces the appropriate amount of work
Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates their efforts on the more important priorities.
Benefits
Robust and affordable health/dental/vision with choices in providers
Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
Two flexible spending accounts (FSAs)
Employer-Paid Term Life and AD&D Insurance
Employer-Paid Disability Insurance
Employer-Paid Life Assistance Program
Health Advocacy
Supplemental medical, legal, identity theft protection
Access to exclusive discount mall
Education and training reimbursement in addition to employer-paid elective learning courses.
Company
Health Plan of San Joaquin/Mountain Valley Health Plan
Health Plan of San Joaquin/Mountain Valley Health Plan (not-for-profit health plan) is the leading Medi-Cal managed care provider in San Joaquin in Stanislaus Counties, now serving Medi-Cal members in Alpine in El Dorado Counties.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Michael Schrader
CEO
Company data provided by crunchbase
