Scripps Health is seeking a Director of HMO Claims Services in beautiful San Diego.
This is a full-time leadership position, eligible for Scripps Health annual Management Incentive Compensation Plan. This position is partial remote and located in San Diego and does require residence in San Diego. The weekly schedule will be 2 days in the office and 3 days remote!
The Director of HMO Payment (Claims) Services for Scripps Health Plan, leads claims payment team and ensures accurate and timely payment of provider and institutional claims. Candidate will manage successful Plan and DMHC Audit performance, staff education and training, and manages PDR process. This individual will interface with all MSO and Plan departments to ensure proper workflow and serve as SME for IS implementations and reporting.
(Note: This is not a revenue cycle – claims billing position)
Successful candidate will demonstrate:
Claims automation optimization.
Claims recovery.
EPIC/Tapestry expertise including workbench and WebI reporting.
Reporting and KPI development and management.
Experience with mailroom.
Requirements
8 years experience in managed care claims, 3 of which in leadership.
Expertise is California DMHC claims regulations, NCQA regulations and health Plan experience.
Strong technical aptitude for computer systems and databases.
Preferred Education/Experience/Specialized Skills/Certification: .
Bachelor’s degree in related field, preferred.
EPIC Tapestry experience.
Strong reporting experience, specifically EPIC Workbench and WebI.
Understanding of institutional and professional claims, implications and codes.
Experience with DMHC audits, health plan audits, CPT and ENM coding
Compensation
$70.08 - $101.80/hour
Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide.
Why It's Great!
Ranked 5th Fortune Best Workplaces in Health Care 2023
Ranked 78th 2023 PEOPLE Companies that Care
Rank 95th in Fortune 100 Best Companies to Work for 2023
Recognized by Newsweek as one of America’s Greatest Workplaces for Diversity in 2024
Nearly a quarter of our employees have been with Scripps Health for over 10 years.
𝘛𝘩𝘪𝘴 𝘫𝘰𝘣 𝘱𝘰𝘴𝘵𝘪𝘯𝘨 𝘱𝘳𝘰𝘷𝘪𝘥𝘦𝘴 𝘢 𝘨𝘦𝘯𝘦𝘳𝘢𝘭 𝘰𝘷𝘦𝘳𝘷𝘪𝘦𝘸 𝘰𝘧 𝘵𝘩𝘦 𝘱𝘰𝘴𝘪𝘵𝘪𝘰𝘯. Fo𝘳 𝘢 𝘤𝘰𝘮𝘱𝘳𝘦𝘩𝘦𝘯𝘴𝘪𝘷𝘦 𝘶𝘯𝘥𝘦𝘳𝘴𝘵𝘢𝘯𝘥𝘪𝘯𝘨 𝘰𝘧 𝘵𝘩𝘦 𝘫𝘰𝘣 𝘥𝘦𝘴𝘤𝘳𝘪𝘱𝘵𝘪𝘰𝘯, 𝘱𝘭𝘦𝘢𝘴𝘦 𝘤𝘰𝘯𝘵𝘢𝘤𝘵 𝘶𝘴 𝘥𝘪𝘳𝘦𝘤𝘵𝘭𝘺.
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