Welcome to HealthsmartMSO.com ::: To provide compassionate quality care to our providers and their patients with integrity!
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:


UM DEPARTMENT MANAGER
HealthSmart MSO is currently seeking a UM department manager. The UM department Manager is accountable for oversight and monitoring all UM activity and UM staffs to ensure timeliness of activities and compliance with UM plan and UM Policies and Procedures.
Experience & Education:
• High School Graduate or equivalent
• Licensed Vocational or Registered Nurse with valid California Nursing License.
• Certified Professional in Utilization Management (CPUM) or Certified Professional in Utilization Review (CPUR) or Medical Assistant with 5+ years experience in UM preferred.
• Experience in managed care environment
• ICD-10, CPT and referral processing experience
• Ability to oversee and direct staffs.
Click here to view the job description

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

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.