Position Summary:

Reviews, codes, and inputs source data from storage media into a computer processing system. Compares output to control totals and makes corrections to codes and batches as necessary. Prepared and distributes output and reports as instructed. Maintains and revises procedural lists, control records and coding schemes to process source data. Performs system maintenance functions in a manner that is responsive to customer needs and support Regal initiatives.

Essential Duties for this position:

• Collects, reviews, encounter data errors from our clearing houses and health plans; responsible to audit output data and work with I.T. on resolving outbound coding issues, identify and resolve production related claims errors that cause encounter rejects.

• Responsible for the entry of claims system support tables and oversight of processes to ensure our groups are meeting 5010 requirements and required to perform specialized area data entry or general data maintenance for eligibility, providers, fee sets and benefits or any other areas that require ongoing support.

• Designs and loads template formatted files and update claims payment system.

• Query, analyze data results and distribute readily accessible data to customers.

• Adheres to Data integrity policies for all system configurations.

• Responsible for the accurate and timely completion of tasks assigned.

• Performs random audits as required to support policies and procedures for data integrity.

• Communicates with management and makes recommendations to improve processes.

• Ensure all systems within the area of responsibility are reliable, responsive and support to the needs of the Medical Group networks.

• Maintains a customer satisfaction focused, service mentality to strengthen and build relationships with our Vendors, Heritage Provider Network and all Medical Groups under HPN.

• Attends administrative meetings as requested.

• All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between$18.50 and $20.50 hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

• 3-5 years of HMO Claims Adjudication experience (Professional & Institutional).

• Experience with EZ-Cap configuration and operation.

• Ability to review and interpret Vendor contract language.

• Industry experience and knowledge of Industry standard Fee schedules and timing of standard fee schedule updates.

• Ability to understand system configuration implications on UM and Claims processes.

• 2 years of Claims experience preferred.

• Excellent written and verbal communication skills.

• Typing/Data entry skills and accuracy.

• Proficient in the use of personal computers, including…

• MS Office applications.

• Internet access and browsing.

• Medical group or IPA operations information systems management experience preferred.

• Understanding of the Health care industry, benefits and eligibility processes preferred.

• Appropriate industry experience and/or certification preferred.

• A bachelor's degree from a four-year college or appropriate industry experience and/or certification.