Community Memorial Health System

  • *Insurance Contract Specialist

    Job Location US-CA-Ventura
    Posted Date 1 week ago(1 week ago)
    Job ID
    2018-3705
    # of Openings
    1
    Shift
    1st – Day
  • Overview

    Community Memorial Health System is a community-owned, not-for-profit organization that consists of two hospitals and 15+ community clinics including family-practice, urgent care, our residency program, and several specialties within Ventura County. We are fully accredited by Det Norske Veritas (DNV), licensed by the California Department of Public Health and ISO 9001:2015 certified. 

     

    Located close to the beach, just 60 miles north of Los Angeles, is Community Memorial Hospital. Our 242-bed, acute care facility, is committed to providing quality patient care in an environment that promotes clinical excellence and innovative leadership.

     

    Ojai Valley Community Hospital, an affiliate of Community Memorial Hospital is a 25-bed general acute care facility designated as a Critical Access Hospital with a distinct part 66 bed skilled nursing facility. OVCH provides inpatient, outpatient, and skilled nursing services for mostly primary and secondary care needs.  In addition, we operate a 24-hour standby emergency department. 

     

    CMHS offers some of the best benefits in the industry, along with great career choices, training, and leadership development. At our facility, our employees share their enthusiasm for life as well as for helping others. As you balance your work life with your other passions, we're there for you every step of the way.

     

    CMHS offers excellent benefits, such as Medical, Dental, Vision, Life, and AD&D insurance. We also offer a comprehensive 403(b) retirement plan, flexible spending accounts, paid time off, and a variety of other great benefits.

     

    If you are interested in joining teams that meld quality care and compassion to create an environment of excellence, please take a moment to discover more about what it's like to work at Community Memorial Health System.

     

    “We are an AA/EEO/Veterans/Disabled Employer”

    Responsibilities

    Insurance Contract Specialist - One (1) Position Available

     

    Position Overview:

    The Insurance Contractor Specialist oversees all the confidential contracting for the CFH physicians and ensures that the appropriate credentialing is in place, to enable the insurance companies to pay the claims accurately and in a timely manner.

     

    Essential Functions and Responsibilities

    1. Prepares applications for contracting all physicians with Medi-Cal, Medicare and all major insurance companies.
    2. Maintains and fosters effective public relations with insurance companies and patients.
    3. Maintains the CAQH Database for all CFH Physicians.
    4. Resolves all contracting issues with insurance companies in a timely manner
    5. Ensures all credentialing information is obtained and kept current in the Physician files.
    6. Maintains and prepares insurance spreadsheets and information on all insurance companies. This includes but not limited to telephone conversations, correspondence, effective dates, and who, what, when and why the information needs to be documented during each encounter.
    7. Oversees MSO contracting, including private office and CFH association.

    Qualifications

    Required:

    • Associate’s Degree in Business Administration or related field.
    • Minimum of 2 years experience in a Business or Billing Office in a hospital, clinic or physician’s office.
    • General math skills and the ability to use a 10-Key.

    Preferred:

    • Extensive knowledge of insurance contracting.
    • Ability to read and interpret insurance contracts and documents.   

    • Ability to speak effectively to insurance companies, customers or employees.

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