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HealthSmart MSO, Inc. offers an excellent work environment and is looking for long- term team members to continue with our growth.

Come Join Our Team!

We have openings in the following Departments:


RN CASE MANAGER
HealthSmart MSO is currently seeking strong Case Manager(s) to provide ongoing and intensive case management services for managed care members. The Case Manager facilitates communication and coordination among all participants of the health care team and the member to ensure that the services are provided to promote quality cost-effective outcomes which includes assessment, planning, facilitation, implementation, coordination, monitoring and evaluation of our member's needs.
Experience & Education:
• Registered Nurse with an AS, BS, or higher degree and current unrestricted CA professional license.
• Minimum five (5) years clinical experience, managed care experience preferred.
• CCM certificate preferred.
• Bilingual skills in either English/Spanish or English/Vietnamese highly desirable.
Click here to view the job description

Concurrent Review Nurse
HealthSmart is currently seeking a Concurrent Review Nurse. The nurse is responsible for concurrent review activities and addressing coordination of care needs for members with complex and chronic care needs.
Experience & Education:
• Licensed Vocational or Registered Nurse with valid California Nursing License..
• Experience in telephonic concurrent review process.
• Experience in Case Management in hospital, IPA or managed care environment.
• Knowledge of medical criteria for length of stay and/or experience with Apollo, MCG and/or InterQual Healthcare Guidelines.
• Basic computer data entry experience.
• Knowledge of CPT/ICD-10 coding.
• Excellent verbal and written communication skills, ability to analyze and problem solve.
Click here to view the job description

CUSTOMER SERVICE REPRESENTATIVE
We are currently seeking a service-oriented individual with excellent customer service skills to provide assistance to our members and providers via telephone. Must be able, to work in a fast paced call center environment answering member questions, processing and documenting information, and providing follow-up assistance as needed.
Experience & Education:
• High school diploma or equivalent required.
• Minimum 2 years' experience in a customer/member service or call center capacity.
• HMO, Medi-Cal/Medicaid and health services experience preferred. Click here to view the job description

CLAIMS ADJUDICATORS
We are currently seeking Claims Adjudicators wtih both Medi-Cal, Commercial, and Medicare experience position.
Experience & Education:
• High school diploma or equivalent required.
• Minimum of three years of Medicare and/or Medi-Cal, Commverical and MEdicare Advanatage/CalDual claims processing experience.
• Knowledge of medical terminolgy, ICD-10, CPT, HCPCS and DRG coding reqquired. Click here to view the job description

Sr. TECHNICAL SUPPORT SPECIALIST
We are looking for a Technical Support Specialist to support the end-users on Windows, Office 365, VOIP phone systems, and other core applications.
Experience & Education:
• High school diploma or equivalent required.
• Minimum of 5 years+ performing help desk or end user support of VOIP telephone systems, Desktop clients or communicators, and voice recording systems.
• Strong knowledge and troubleshooting experience with Active Directory, Exchange Server, and roaming profiles. Click here to view the job description


CLAIMS ADJUDICATORS
We are currently seeking Claims Adjudicators wtih both Medi-Cal, Commercial, and Medicare experience position.
Experience & Education:
• High school diploma or equivalent required.
• Minimum of three years of Medicare and/or Medi-Cal, Commverical and MEdicare Advanatage/CalDual claims processing experience.
• Knowledge of medical terminolgy, ICD-10, CPT, HCPCS and DRG coding reqquired. Click here to view the job description




ENCOUNTER ANALYST
The Encounter Team is responsible for ensuring that services provided to health plan members are received and submitted to regulatory agencies and stakeholders in accordance with governance standards. All data received by the Encounter Team are captured, tracked, analyzed, process corrected, and reported.
QUALIFICATIONS
• A strong understanding of the encounter process for CA. DHCS, CMS rules/regulations.
• Working knowledge of EDI files including: 837P, 837I, 277CA, 999.
• Ability to perform Ad-Hoc queries and data transformation for reporting.
• Proficient with developing SQL procedures in SQLServer.
• Knowledge of medical terminology, diagnosis and procedure codes, pricing, and provider contracts.
• A strong understanding of the encounter process for CA. DHCS, CMS rules/regulations.
• Working knowledge of EDI files including: 837P, 837I, 277CA, 999.
• Ability to perform Ad-Hoc queries and data transformation for reporting.
• Proficient with developing SQL procedures in SQLServer.
• Knowledge of medical terminology, diagnosis and procedure codes, pricing, and provider contracts. Click here to view the job description

QM OUTREACH SUPPORT
This position is responsible for project organization and maintenance, monthly/quarterly/annual reporting, member/provider outreach and any additional support as needed. This position assists in the coordination of various projects and activities to include planning, organization, implementation, maintenance, and timely completion of interventions, data manipulation and data management, project reporting, and status updates.
QUALIFICATIONS
• High School Diploma; Concurrent college enrollment required.
• Experience working in managed health care industry.
• Knowledge of managed care quality/performance programs, HEDIS/STAR, HCC/CDPS risk-adjustment and related timelines and activities.
• Data collection and project coordination/organization experience required.
• Advanced knowledge software programs such as Microsoft Word, Excel, and Access, including analytical functions, pivot tables, etc.
• Excellent oral and written communication skills.
• Strong research, methodology, and analytical skills; advanced organizational skills and attention to details; excellent time management skills with the ability to prioritize and work under pressure in a fast paced environment; manage several tasks and projects simultaneously.
• Ability to work with multiple cross-functional project teams in order to meet project schedules, costs, and performance objectives.
Click here to view the job description

RISK-ADJUSTMENT CODER
Will act as liaison between IPA/MSO, contracted physicians and other providers (ancillary) and Health Plans. This position maintains the credibility of the Quality Management department by performing medical/clinical chart review and data collection, analysis and coding to capture and obtain data and information related to risk adjustment, STAR/HEDIS and other quality and performance improvement measures and metrics. Must be able to communicate/interact effectively and work collaboratively with physicians, other clinical/office staff and other members of the team regarding various projects and initiatives. This position will require physician/provider/staff education on proper documentation and coding of diagnoses codes (ie, HCC, CDPS, Risk-Adjustment) to follow coding guidelines, monitor completion of required member preventive services (ie. STAR, HEDIS, Quality measures), as well as determine physician compliance and improvement. Must have active Certified Professional Coder, CPC certification.