Posted 04/30/09
Cerritos, CA Healthcare Corporation          60-75K                                                                                   

Cerritos, CA  Healthcare Corporation                                                                                                            

MEMBER SERVICES REPRESENTATIVE

The Member Services Representative assists plan members with their concerns or complaints and provides the necessary information and education to resolve concerns.

Essential duties and responsibilities include, but are not limited to:

1.     Explain the plan’s procedures, protocols, benefits, services, and any other necessary information to the members who telephone or visit the Member Services Department.

2.     Complete and maintain a call record for each member contact and answer all incoming member phone calls within the department’s goal timeframe.

3.     Respond to complaints against Healthplan and its contracted facilities by utilizing the departments Complaint/Grievance Policy and Procedure.

4.     Make all attempts to resolve all member disenrollment/cancellation requests, complaint/grievances, and assist the member with their questions or concerns.

5.     Process all requests for Primary Care Physician (PCP) changes, emergency dis-enrollments, and plan delegations.

6.     Assist members with their transportation needs. Schedule and arrange member transportation. Verify benefits and maintain a log of all scheduled transportation needs for the members and report outcome on a monthly basis. Report shall be used to compare to expenses.

7.     Assist with Member Outreach programs and implementations as needed.

8.     Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.).

9.     Perform other duties as assigned by Manager.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.     Education and/or Experience: High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

2.     Certificates, Licenses, Registrations: None required.

3.     Other Qualifications:

a. Associate’s degree (A.A.) degree (preferred).

b. Two years customer service/telemarketing experience.

c. Medical front office experience.

d. Direct sales or related experience, preferably in the Medi-Cal, Commercial, or Medicare Managed Care industry.

e. Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans.

f. Bilingual (English/Spanish) required.

 Skills and Abilities

1.     Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

2.     Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.

3.     Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

4.     Computer Skills: Strong computer skills.

5.     Other Skills and Abilities:

a. Computer literate, typing 40+ words per minute.

b. Excellent communication skills, oral and written.

As Medical Assistant I Float will be responsible for:

·         Reviews patient medical records prior to visit to ensure chart readiness for physician.

·         Responsible for handling incoming telephone inquiries from patients and routing calls appropriately.  

·         Complete documentation to ensure accurate medical records. 

·         Assure that physician has signed chart, reviews physicians orders to verify that all orders have been carried out in accordance to the checkout process. Ensure referral form is complete and accurate, attaches clinical notes per policy and procedure.

·         Writes appropriate and complete messages, handles or refers messages to appropriate personnel. Interview patients, measures vital signs, pulse rate, temperature, blood pressure, weight, height, and records information on patients' chart. 

·         Prepare treatment room for examination of patients, assists physician with procedures, cleans examination room and sterilizes appropriate equipment after use.  Maintain patient's dignity by protecting the patient's right to privacy, confidentiality and safety.

·         Administer prescribed medication orally or by injection, following the 6 rights, after a physician, RN or LVN has verified the correct dosage and medication. 

·         Document time, dosage, and route on patient's chart.

·         Perform electrocardiograph (EKG), pulse oximetry, inhalation treatments and operates other equipment.

·         Follows the policy and procedure for the DKA process (when patients do not keep their appointment).

·         Communicate to the front office and patients the status of the approximate provider wait time on an hourly basis. Schedules patients for routine diagnostic tests and appointments per policy and procedure.

Qualified candidates

·         High School diploma,

·         Medical Assistant certificate from recognized school, current CPR with minimum 2 + years of Medical Assistant experience; strong phlebotomy skills, excellent organizational and patient care skills.

·         Bilingual in Spanish preferred.

Healthcare Corporation 
Cerritos, CA 

Looking for a CPC Certified Coder. Position is a full time, permanent position paying $23-$25hr. 

Coding Analyst

The Coding Analyst must be certified in coding (CPC) and have a minimum of 1-2 years experience in a physician office coding.

This position will demonstrate success in chart auditing, must have extensive knowledge of E&M documentation, ICD-9, CPT, HCPCS coding and CMS guidelines.

Responsibilities will be to review physician documentation form source documents to ensure appropriate diagnostics and procedural coding has occurred in accordance with all standards related to coding and billing compliance.

Medicare Risk Adjustment HCC coding experience desirable. ER and surgical claim review, provides feedback from reviews to physicians and provides training regarding documentation, billing and coding to physician.

Must have excellent communication skills.

Credentialing Coordinator

Ideal candidate will have a minimum of 5 years previous Credentialing experience in HMO/Managed Care setting, Must possess extensive knowledge of NCQA, CMS, DHS, PPO and Health Plan Standards. Must also be knowledgeable of state and other regulatory requirement for credentialing. Excellent, written/verbal and organization skills required. Must be proficient in Excel, Word, and Access.

MUST HAVE PPO AND GOV'T CREDENTIALING EXPERIENCE.

This in the Cerritos area, for consideration please send me a Word format of your resume.

Credentialing Department $15-$20hr

Part-Time position M-F 1-5pm

Cerritos, CA                                         PERM POSITION

NURSE PRACTIONER

We are currently looking for a Nurse Practitioner in the Cerritos area. This position will be within Management and Treatment of General Family Practice. For consideration please e-mail me a Word format of your resume.

The duties will include:

1. Peds,

2. Women Health,

3. Care of the elderly.

The potential candidate will work along with a Family Physician and will be responsible for a daily patient load focusing on primary care issues such as Formulary/Non-Formulary Medication Adjustments, ordering labs/tests, and managing chronic/acute medical problems. Bilingual Spanish preferred.

Glendale, CA CPA Firm                                                                                                                               
$80K Senior Tax Accountant

JOB DESCRIPTION:
Rapidly growing Glendale CPA Firm seeks a highly motivated and experienced Tax Manager or Senior Tax Accountant with a minimum of 4 to 5 years experience in public accounting. This individual should possess strong tax knowledge, excellent communication, organizational and analytical skills. Individual will have client responsibilities and opportunities for advancement in growing firm. 

RESPONSIBILITIES:

• Review and preparation of c-corp, s-corp, individual and partnership tax returns.
• Supervision of staff and work in process
• Tax research involving federal, state and local tax jurisdictions.
• Recommend tax planning and strategies for individuals and corporations. 
• General business consulting on financial and tax issues.

  REQUIREMENTS:

   

   

   

   

·         Bachelor's degree in Accounting

·         Minimum of 4-5 years experience in public accounting

·         CPA and/or MBT preferred

·         Strong business and individual taxation background

·         Strong accounting background

·         Strong written and oral communication skills

·         Proficient in tax preparation software, on-line tax research and Microsoft Excel/Word

Cerritos, CA                                                                                                                                      

CLAIMS EXAMINER

JOB DESCRIPTION:

Seeking a sharp individual with a strong level of commitment and accountability with at least 3 years experience processing claims in a managed care environment.

JOB REQUIREMENTS:

Highly experienced in contract verbiage, divisions of financial responsibility, ICD9 coding, CPT coding, revenue coding, and member benefits. Candidate must have a strong level of knowledge in processing and pricing inpatient and outpatient surgical claims. Strong knowledge in DRG's and APC's. EZ-Cap experience a plus.