Career Opportunities

How to Apply

  • Online – by Email
    Email your cover letter and resume. Please included your salary requirements to: HealthSmartHR@healthsmartmso.com
  • Letter – by mail
    Mail your resume with work history. Please included your salary requirements to address:
    HealthSmart MSO, Inc.
    Attn: Human Resources P.O. Box 6300 Cypress, CA 90630-6300
  • 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:

    ACCOUNTING COORDINATOR
  • Under the supervision of the Controller, the Accounting Coordinator position is accountable for assisting Controller to ensure timeliness of preparing cash disbursement packages supported by proper purchasing and receiving documentation. Ensures that we are in compliance with Accounting Policies and Procedures
  • EDUCATION & EXPERIENCE REQUIREMENTS:
    • High school graduate, some college preferred.
    • At least two years' experience in accounting or equivalent preferably in a health care environment.
    • Good oral and written communication skills and demonstrate and the ability to read, write and communicate fluently in English.
    DUTIES AND RESPONSIBILITIES:
    • Responsible for Importing and/or Inputting Capitation and Claims checks into QuickBooks for all IPA’s and Hospital Accounts.
    • Responsible for posting daily deposits to the IPA and Hospital cash activity report.
    • Prepares and reconciles all bank reconciliation monthly.
    • Prepares Management Fee worksheet reports monthly to assure cash disbursements.
    • Prepares and reconciles all account analysis on all IPA and Hospital Financial Statement.
    • Click here to view the job description
    SENIOR INSTITUTIONAL CLAIMS EXAMINER
  • The Senior Institutional Claims Examiner accurately reviews, researches and analyzes professional, ancillary and institutional inpatient and outpatient claims. Essential Functions and Responsibilities of the Job: Knowledge of CPT/HCPC, ICD-10 codes and guidelines. Comprehensive knowledge of DMHC, DHCS and CMS guidelines to accurately adjudicate Medicaid, Commercial and Medicare Advantage claims. Comprehensive knowledge of various fee schedules and CMS pricers for outpatient/inpatient institutional, ancillary and professional claims, including, but not limited to Medicare fee schedules, DRG, APC, ASC, SNF-RUG.
  • EDUCATION & EXPERIENCE REQUIREMENTS:
    • High school graduate, some college preferred.
    • Experience in a managed healthcare environment for a minimum of ten (10) years.
    • Working knowledge of computers and software programs such as Microsoft Word, Excel, Power Point.
    • Expertise in ICD, CPT-4, and HCPCS coding structure.
    • Knowledge of CMS, DHCS and DMHC regulations required.
    • Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and industry standard reimbursement methodologies required.
    • Knowledge and familiarity of Health Plan and IPA/Medical Group benefits and contracts and Division of Financial Responsibility (DOFR’s).
    • Experience in working CMS Level 1 Appeals and Grievance cases a plus.
    • Process all types of claims, such as HCFA 1500, outpatient/inpatient UB04, high dollar claims, COB and DRG claims.
    DUTIES AND RESPONSIBILITIES:
    • Responsible for the processing of outpatient/inpatient institutional & professional claims and the comprehensive knowledge of using CMS pricer, 3M Core Grouping Software & Encoder Pro+. Knowledge of DRG, APR-DRG, APC, ASC, & SNF-RUG payment methodologies required.
    • Responsible for the processing of claims that are either the financial responsibility of the assigned IPA or capitated Hospital.
    • Responsible for validating the diagnosis and procedure codes against the authorized services on Inpatient claims.
    • Responsible for the resolution of Provider Disputes (PDR’s) and generate required Acknowledgement and Resolution Letters to send to providers.
    • Responsible for requesting additional information required to adjudicate claims by preparing and sending Development Letters and or Notifications to providers.
    • Responsible for generating accurate Denial Letters for claims denied as member liability.
    • Click here to view the job description
    INTAKE COORDINATOR
  • Assist in all case management and concurrent review activities for assigned IPA(s), ensuring timeliness and accuracy. Responsible for opening and maintaining case management files for assigned IPA(s).
  • EDUCATION & EXPERIENCE REQUIREMENTS
    • High School Graduate.
    • Medical Assistant, experience in Managed Care and/or referral processing, preferred.
    • Experience in managed care environment.
    • ICD-9, and ICD-10 coding experience.
    • Organization, Data Entry and Filing Skills.
    ACCOUNTABILITY/DUTIES/RESPONSIBILITIES:
    • Accurate and timely processing of concurrent review referrals for assigned medical group(s), including:
      1. Eligibility verification
      2. Benefit verification against established criteria for inpatient hospitalizations
      3. Review of prior activity
      4. Timely data entry
      5. Ensure coordination of services, where necessary
      6. Ensure timeliness of notification to providers
      7. Maintain accurate detailed notes of activity related to inpatient hospitalizations
    • Responsible for monitoring and delivering of all information received via the Fax, including:
      1. Accurate date stamping
      2. Timely & accurate delivery
      3. Maintenance of Fax machine
    • Responsible for opening and maintaining case management files, including:
      1. Creating new cases in Concurrent Review Module
      2. Checking eligibility and attaching records to the electronic file
      3. Completing Medical Record Request form and faxing to facilities
      4. Maintaining E-Health system indicating open and closed cases
    • Maintain professional interaction with Medical Directors, Physician Reviewers, IPA Physicians and staff/coworkers, etc.
    • Report any delays in obtaining the required records and data entry of authorization to Supervisor.
    • Obtain assistance and direction with difficult authorizations from UM Supervisor or UM Lead.
    • Maintain compliance with HIPAA rules and regulation.
    • Mailing, as required.
    • Other duties, as identified/assigned.
    • Click here to view the job description
    UM COORDINATOR
  • Assist in all UM referral activity for assigned Medical Group(s), ensuring timeliness and accuracy.
  • EDUCATION & EXPERIENCE REQUIREMENTS
    • High School Graduate.
    • Certified Professional in Utilization Management (CPUM) or Certified Professional in Utilization Review (CPUR) or Medical Assistant with 2 years experience in UM.
    • Experience in managed care environment.
    • ICD-10, CPT and referral processing experience.
    • Data Entry Skills.
    ACCOUNTABILITY/DUTIES/RESPONSIBILITIES:
    • Accurate processing of referrals for assigned medical group(s), including:
      1. Eligibility verification
      2. Benefit verification
      3. Review of prior activity
      4. Data entry of timely outcome (approval, denial) and follow up
      5. Ensure coordination of services, where necessary
      6. Ensure timeliness of notification to providers (and members, when indicated)
      7. Maintain accurate detailed notes of activity related to referrals.
    • Timely processing of referrals for assigned medical group(s) according to timeliness chart.
    • Maintain coordination of services between health plans, CCS, Case Management, Linked services, etc.
    • Maintain professional interaction with Medical Directors, Physician Reviewers, IPA Physicians and staff, Nurse/Case Managers for Outpatient coordination of Case Management cases, Fellow coworkers, etc.
    • Report any delays in authorization to UM Supervisor or Lead
    • Obtain assistance and direction with difficult authorizations from UM Supervisor or UM Lead.
    • Maintain and update Matrix logs.
    • Maintain Inter-rater reliability score of 95%. Implement any requests for corrective action immediately.
    • Maintain compliance with HIPAA rules and regulation.
    • Other duties, as identified/assigned.
    • 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.
    • Bilingual skills in English-Spanish and/or English-Korean highly desirable.
    • HMO, Medi-Cal/Medicaid and health services experience preferred.
    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
    CREDENTIALING COORDINATOR
  • The credentialing coordinator position is responsible for the timely and accurate data entry and processing of provider(s) who are being initially credentialed or recredentialed for a Medical Group/ IPA that adhere to NCQA, CMS/MA, DMHC and DHCS regulations.
  • EDUCATION/EXPERIENCE REQUIREMENT
    • 2 years of previous experience with initial credentialing & re-credentialing experience from a Health Plan, MSO or Hospital setting
    • 2 years of previous experience with Word, and Excel
    • 2 years of previous experience with handling multiple medical groups/IPA file processing.
    • 2 years of previous knowledge working with CAQH Applications or working with California Participating Practitioner Applications
    • Working knowledge of ICE Shared auditing for Medical Groups
    • Good communication skills