**Responsibilities**

This position is responsible for administering complex payable functions as related to Medicare risk contracts, commercial capitation. This position is also expected to calculate and submit reinsurance claims by merging multiple systems data downloads into spreadsheets and employing complex pricing methodology to value all internal and external capitated claims on an as needed basis. This position will be responsible to pull queries and reports from claims databases for Managed Care Contracting, General Ledger and other management as needed.

+ Prepare monthly and quarterly compliance reports for claims timeliness and provider disputes accurately

+ Verify authorization in IDX, with health care provider, complete benefit determination, process complex claims with manual calculations using current National Drug Codes and Average Wholesale Pricing in IDX system

+ Report any non-compliant issues with regards to C.I.A. guidelines to management prior to processing

**Qualifications**

**Required:**

+ Three years of clerical experience in medical claims adjudication Equivalent combination of education and experience

**Preferred:**

+ Applied science in medical billing and claims adjudication or equivalent

**Overview**

Dignity Health, one of the nation’s largest health care systems, is a 22-state network of more than 9,000 physicians, 63,000 employees, and 400 care centers, including hospitals, urgent and occupational care, imaging and surgery centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved. For more information, please visit our website at www.dignityhealth.org. You can also follow us on Twitter and Facebook.

One Community. One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV)

**Pay Range**

$24.00 - $32.91 /hour

We are an equal opportunity/affirmative action employer.