MEDICARE CLAIMS MANAGER

CalOptima is a nationally recognized County Organized Health System authorized by the state and federal governments to administer MediCal benefits to approximately 300,000 deserving residents of Orange County, California residents through mulitiple product lines. Our mission is to provide our members with access to high quality health care services delivered in a cost-effective and compassionate manner.

CLAIMS MANAGER - ONECARE

The Claims Manager promotes, integrates, implements and oversees the day-to-day operations involved in processing OneCare MediCare Advantage claims. This position is responsible for providing assistance and guidance to OneCare claims supervisors and implementing necessary controls, work flow and audit review procedures. This position also develops desktop processes, policies and procedures for the MediCare line of business.

 

The Claims Manager must be knowledgeable in Claims Information Systems logic in order to support and define claims processing requirements. Knowledge of RBRVS, DRG?s, Stoploss, CPT-4/HCPCS, ICD-9 and Medicare Fee-scheduling is essential for this position. Prior knowledge of medical terminology, MediCare/MediCal guidelines and regulations are also required. This position requires seven years experience with MediCare claims processing in a MediCare Managed Care environment that would have developed the knowledge and abilities listed above. A Bachelor?s Degree in a health care field or related field is highly desirable.

CalOptima offers an excellent work environment that includes flexible scheduling plans, a highly competitive benefits package and an organizational mission that drives our employees to excel!