PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women's health, urgent care and emergency services.
The Claims Revenue Recovery Specialist reports directly to the Claims Revenue Recovery Coordinator. He/she is responsible for providing support in the organization, interpretation, and communication of the health plan contracts and working with the Claims Director on development of processes and implementation of those processes for the recovery of monies due to the organization.
Fully developed skills in the following areas required: negotiation, personal computer (spreadsheet, database, word processor), contracts analysis, claims adjudication process, and effective communication and presentation skills. Thorough understanding of reimbursement methodologies as they relate to managed care contracting is also required. Basic understanding of medical care and medical terminology preferred.
Bachelor's degree in one of the following areas: Business Administration, Accounting, Finance or Healthcare Management OR equivalent education/experience in the managed care/healthcare field. Previous experience in HMO or IPA environment. Knowledge of compliance issues as they relate to claims processing.
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V
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