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Excellent full-time opportunity to work in a progressive organization providing management and delegated services for physician groups:

The right candidate will enter requests for refund letters as identified by the Provider Disputes Analysts. Calls providers as indicated on outstanding refund requests. Retracts uncontested refunds from provider payments within thirty (30) working days of request. Posts refund requests upon receipt in the EZ-CAP system. Posts health plan deductions from capitation. Prepares capitation deduction forms from primary care and fee for service providers for review by Administration. Pursues refund requests from members for services paid as required by Assembly Bill 1324.

Minimum two years experience in managed health care and one year in customer service.Must have clear understanding of all aspects of the managed care environment, including Claims, Medical Management, Eligibility, and Customer Service.Previous experience with software applications for claims, EZ-CAP preferred.Must be proficient in claims terminology, CPT, ICD-9, and HCPC coding procedures.Must be accurate with numbers and excellent communication skills.Must type a mimimum 55 wpm.

SCPMCS offers competitive salaries and excellent benefits, including:Medical/Dental/VisionFlexible Spending AccountsLife InsuranceShort and Long-Term Disability Insurance401(k) Retirement PlanPaid Time OffIf interested in pursuring this position, please fax your resume to (858) 824-7159 or email: jobs@scpmcs.org

• Location: Mira Mesa
• Compensation: Based on experience
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