Home > About Us > Job Openings


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:

HEALTH PLAN & CLIENT OVERSIGHT SUPPORT
HealthSmart MSO is currently seeking a Health Plan & Client Oversight Support.
Experience & Education:
• Experience with UM reporting statistics and trending.
• Must be detail oriented and have knowledge of Managed Care principles.
• Strong in Microsoft Word & Excel.
• ICD-10, CPT Coding experience
• Values and works well in a team environment.


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

UM NURSE REVIEWER
HealthSmart is currently seeking a UM Nurse Reviewer. This position, under the direction of the Director of Utilization Management, is responsible for reviewing and processing requests for authorization and notification
of medical services from health professionals, clinical facilities and ancillary providers. The incumbent is responsible for tasks/functions related to HealthSmart MSO’s prior authorization and referral process.
He/she is responsible for applying HealthSmart MSO’s medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers. He/she will directly interact with provider callers, acting as a resource for their needs.
Experience & Education Requirements:
• High School Graduate or equivalent required.
• Current unrestricted RN or LVN License to practice in the State of California.
• Minimum of three (3) years current clinical experience preferred.
• IPA and Managed care experience preferred.
• Knowledge of medical criteria for Apollo, MCG and Medicare/Medi-Cal guidelines.
• Excellent telephone skills required.
• Computer experience desirable.
• Excellent interpersonal skills.
• ICD 10- CM and CPT/ HCPCS Medical Coding.
• Strong problem solving, organizational skills and time management skills with the ability to work in a fast-paced environment.
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

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 and QUALITY LIAISON
The risk adjustment coder and quality liaison will work directly with the risk adjustment manager to support the organization’s revenue and the group’s overall performance. The position will assist to maximize clinical diagnosis codes captured from a retrospective and prospective chart review processes, as well as improve coding and data capture of quality/performance measures. She/he performs medical record reviews at contracted provider practices for completeness, accuracy, compliance with Federal and State laws, regulations and coding guidelines; serves as a liaison between organization, medical group and physicians. Additional duties and responsibilities will be assigned.
EDUCATION REQUIREMENT
• AHIMA and/or AAPC Certified Coding Specialist (CCS), Registered Health Information Technology (RHIT) or Certified Professional Coder (CPC) required.
• AA and/or BA Degree in related field preferred.
EXPERIENCE/KNOWLEDGE and SKILL REQUIREMENTS
• Current Coding Certification (CPC, CCS, RHIT) through AAPC and AHIMA is mandatory. Valid credentials must be maintained during employment.
• 2 + years risk adjustment/HCCs experiences methodology required with an emphasis in a managed care environment within the health plan or medical groups, strong chart review auditing and data abstraction skills.
• Knowledge of CMS-HCC model, Medi-Cal and commercial coding and documentation guidelines.
• Ability to interpret, analyze and abstract data based on the provider documentation.
• Ability to identify HCC coding improvement opportunities and provide feedback to physicians on proper clinical documentation, compliance and coding guidelines.
• Knowledge of medical anatomy and terminology, ICD-10- CM and CPT codes, CMS-HCC model and documentation guidelines, NCQA HEDIS/P4V clinical measures, and State CDPS risk adjustment programs.
• Computer proficiency in MS Office (Excel with Pivot tables, functions, Word and Power Point).
• Excellent organizational, time management and problem-solving skills; detail-oriented; must possess a high degree of accuracy, efficiency and dependability.
• Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet projects, deadlines and its business needs.