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Claims Examiner in 505 City Parkway West
The Claims Administration Department is responsible for managing and processing of all medical claims in accordance with industry standards and regulations, ensuring accuracy and timely reimbursement to healthcare providers.
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Certified Coding Specialist in 505 City Parkway West
The Coding Team collaborates with the Claims Administration team to identify process improvement opportunities to increase department efficiencies. Ensures current coding methodology and modifier rules are appropriately applied for accurate claim reimbursement. Assists CalOptima Health Business Units regarding conflicting, ambiguous, or non-specific medical documentation identified regarding coding protocol and Medi-Cal or Medicare fee schedules/rates. Conducts coding validation of submitted claims, which includes, but is not limited to, review of professional, inpatient, and outpatient claims data and or medical records to determine appropriateness of procedures and diagnosis codes billed. Provides analytical support and technical expertise on requests from CalOptima Health Business Units regarding claims processing or claims program-related implementation.
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Intern (Budget) in 505 City Parkway West
The Budget Department is responsible for planning, developing and managing the financial resources of the organization. The main responsibilities include developing and managing annual operating budgets and providing insights and recommendations to support strategic decision-making.
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Customer Service Representative (General) in 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and provider with questions related to the Med-Cal programs.
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Customer Service Representative, Sr. (OneCare) (Bilingual Required) in 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and provider with questions related to the Med-Cal programs.
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