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Sr Manager, Operation and Business Configuration (Sr Manager I) CalOptima CalOptima Health is seeking a highly motivated Sr Manager, Operation and Business Configuration (Sr Manager I) to join our team. The Sr Manager I for Operation and Business Configuration will function as a primary point of contact for the claims analytical support unit which consists of data analytics, process improvement and claims clearinghouse vendor oversight. The incumbent will collaborate with leadership on the development and implementation of analytical tools to identify department trends and will manage dedicated resources for the day-to-day operations to carry out the strategic and tactical execution of CalOptima Health business operations, ensuring compliance with business rules and government regulations. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>40% - Leadership Functions
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.</li>
<li>Hires, manages, trains, reviews and sets goals for the department and staff.</li>
<li>Provides an environment that engages staff to fully participate in the overall department functions and workload balancing strategies.</li>
<li>Develops and implements corrective action plans and trains staff as needed.</li>
<li>Establishes and manages teams to a set of standards and governance to improve performance and support effective development and outputs.</li>
<li>Provides management oversight and direction to Data Analysts Business team and serves as a liaison with internal and external entities such as Clearinghouse and health networks to ensure claims and authorization data load integrity.</li>
<li>Provides management oversight and direction to the Clearinghouse Data Analyst team for intake requirements, analysis, conducting clearinghouse user acceptance testing and identifies impacts to systems and processes.</li>
<li>Tracks and trends teams performances by way of dashboards, monitoring day-to-day activities of each claim operational areas, claims operational vendors and all clearinghouses.</li>
<li>Represents Claims department and participates in regulatory audit presentations and demonstrations and conducts follow up remediation action items from the audit as needed.</li>
<li>Works collaboratively with the Office of Compliance, Information Technology (IT), claims vendors and internal business teams on regulatory changes impacting claims adjudication and data integrity.</li>
<li>Manages all claims vendor contract or scope of work (SOW) renewals and takes the lead for any request for proposal projects.</li>
<li>Participates in CalOptima Health's enterprise projects impacting claims or operational payments and procedures/policies.</li>
<li>Conducts claims presentation to staff, senior level leadership and CalOptima Health network providers.</li>
<li>Maintains quality goals and production level within the department by collaborating with Claims department leadership teams and ensures that performance goals are consistently met and/or exceeded.</li>
<li>Anticipates future demands of initiatives, strategic plans and regulatory updates and design/implement solutions to meet these needs. </li>
</ul>
</li>
<li>35% - Program Oversight
<ul>
<li>Ensures compliance with applicable internal policies and procedures and external state and federal regulations for multiple product lines (Medi-Cal, Medicare, Commercial (Covered California) and Program of All-Inclusive Care for the Elderly (PACE). Ensures overall claims adjudication is in accordance with the California Department of Managed Health Care (DMHC), California Department of Health Care Services (DHCS) and Centers for Medicare &amp; Medicaid Services (CMS) health plan regulatory requirements and guidelines.</li>
<li>Intakes and reviews All Plan Letters (APL), CMS bulletins and regulatory guidance; oversees the development, timely and accurate implementation and publication/posting of claims-related regulatory requirements and reporting.</li>
<li>Serves as the primary point of contact to answer questions related to system configuration business rules, various claim adjudication issues and resolves complex claims or benefit adjudication issues for department staff as well as other internal customers; responsible for the identification and resolution of provider claim issues including support of provider education and customer service staff in communications back to providers.</li>
<li>Reviews and maintains department policies and procedures, recommends changes for more efficient operations, drafts new policies and procedures for director's review, communicates changes and updates to staff when appropriate.</li>
<li>Stays current with regulatory guidelines impacting essential functions and data requirements. </li>
</ul>
</li>
<li>20% - Technical Operations
<ul>
<li>Develops the claims data standards and deploys automation tools to obtain and process claims data from different sources. Constructs datasets to analyze, inform, identify trends and support stakeholder decision-making.</li>
<li>Identifies claims transaction inconsistencies, as well as implementation of controls and changes to systems and policies that support claims adjudication, thereby minimizing incorrect claims payment.</li>
<li>Manages activities/service requests with Facets configuration, IT and EDI teams to scope, prioritize, and implement requirement changes.</li>
<li>Manages and intakes all program implementation impacting Facets and systems supporting the Claims, Grievance and Appeals Resolution Services (GARS)/Provider Dispute Resolution (PDR) and Customer Service operations. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in health information management, business administration, health administration or related field PLUS 5 years of experience in information technology business experience implementing claims adjudication programs and projects in a health plan setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>5 years of management/leadership experience that manages claims operation from intake to output of the claims payment required. </li>
<li>5 years of experience utilizing Microsoft technologies required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6372553&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 22, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6372553" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-operation-and-business-configuration-sr-manager-i-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-f254b5d52e384f44aad2de542f28a181

Sr Manager, Operation and Business Configuration (Sr Manager I)

Business Analyst (Claims) CalOptima CalOptima Health is seeking a highly motivated Business Analyst (Claims) to join our team. Under general supervision, the Business Analyst (Claims) will identify and design solutions within Claims Administration processes. The incumbent will interpret regulatory letters and memos to identify the impact on claims processes. The incumbent will be responsible for implementation of changes through project management, system configuration and User Acceptance Testing (UAT). The incumbent will work independently and perform more complex analytical and administrative responsibilities. The incumbent will exercise discretion and judgment and may coordinate a function and the work of others within the program or representing the program/project. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Works in conjunction with the Claims Administration team, Contracting, Provider Relations, Coding Initiatives and/or Information Technology to implement benefit or process changes that impact system configuration due to federal and state notices.</li>
<li>Performs system research and testing to ensure regulatory, coding, contract updates and configuration changes produce expected results; ensures that all documentation accurately reflects the current status of changes and outstanding issues identified during testing.</li>
<li>Creates business user test scenarios and testing schedules, including time estimates and deadlines, monitors milestone completion, tracks all phases of testing and provides timely reporting of issues that impact the testing progress.</li>
<li>Communicates to the Claims Administration management team, training and staff regarding any system enhancements or changes, including any process deficiencies identified from claims look-back analysis and UAT.</li>
<li>Assists the Claims Administration management team in identifying training and development of desktop procedures and policies for the Medi-Cal and Medicare lines of business impacted by system and/or regulatory changes.</li>
<li>Provides analytical support and technical expertise on requests for information from executives, directors and other staff regarding claims.</li>
<li>Remains updated on state, federal and commercial health care environments, identifying impacts to CalOptima Health programs and claims processes utilizing MedLearn, Centers for Medicare &amp; Medicaid Services (CMS) Updates, Medi-Cal Provider Bulletins, Medi-Cal manuals and Industry Collaboration Effort (ICE).</li>
<li>Reviews ad-hoc analysis and generates reports as requested.</li>
<li>Collaborates with Claims Administration management process improvement, project management and Training Program Coordinator to identify process improvement opportunities.</li>
<li>Partners with trainer and Claims Administration management team to create or update document processes and procedures.</li>
<li>Serves as subject matter expert with end-to-end claims adjudication/processing.</li>
<li>Facilitates communication on claims related topics. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, management or related field PLUS 2 years of both Medicare and Medi-Cal claims adjudication experience required, including experience with Current Procedural Terminology (CPT-4), Healthcare Common Procedure Coding System (HCPC) coding or International Classification of Diseases (ICD-10); an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6372575&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 22, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6372575" target="_blank">https://jobs.caloptima.org/jobs/business-analyst-claims-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-e67e1e573a7a6948a011a0304b064368

Business Analyst (Claims)

Customer Service Representative CalOptima CalOptima Health is seeking a highly motivated Customer Service Representative to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Health's members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers. Position Information: 
<ul>
<li>Department: Customer Service </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>80% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Maintains departmental productivity and quality standards.</li>
<li>Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.</li>
<li>Serves as a resource for other team members. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.</li>
<li>Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.</li>
<li>Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.</li>
<li>Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High School diploma or equivalent PLUS 6 months of experience in a call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>Typing speed of 35 words per minute (WPM) required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>6 months of Medi-Cal/Medicaid or health services experience.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6337909&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 15, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6337909" target="_blank">https://jobs.caloptima.org/jobs/customer-service-representative-505-city-parkway-west-california-united-states-7d5bf04b-390c-46e1-91cb-12f6a1dd6e9a</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-fa21bddb4c4a0240925cf86da2f60f27

Customer Service Representative

Civil Rights Investigator and Complaint Resolution Officer

<h3>Job Description</h3>
Job DescriptionDescription:
The Patient Service Representative serves as the first point of contact for patients calling or arriving at the clinic. This position is responsible for greeting and checking-in patients, obtaining patient information, collecting payments, assisting with necessary paperwork, and fulfilling other customer service or administrative duties.
Essential Duties &amp; Responsibilities:
<ul>
<li>Registering, scheduling and re-scheduling patients for initial appointments and follow-ups</li>
<li>Entering data for patients into an electronic medical record (EMR)</li>
<li>Answering patient questions about billing and payments and collect payments</li>
<li>Screening incoming calls to provide the proper routing to other departments when necessary</li>
<li>Verifying insurance eligibility</li>
<li>Accepting lab drop offs from patients</li>
<li>Other duties as assigned </li>
</ul>
Requirements:
Education, Experience and Qualifications:
<ul>
<li>Previous experience in front office or similar role preferred</li>
<li>High school diploma or GED</li>
<li>Experience using an Electronic Medical Record system as well as foundational computer skills, including Microsoft Office Suite and the Internet. Ability to navigate at a basic level within web-based applications.</li>
<li>Ability to learn and follow HIPAA requirements and respect patient privacy rights</li>
<li>Strong organizational and multitasking skills</li>
</ul>
Interpersonal Skills:
<ul>
<li>Oral communication- Speaks clearly and persuasively in positive or negative situations; listens to others without interrupting and gets clarification when needed; responds well to questions</li>
<li>Written communication- Writes clearly and informatively; edits work for spelling and grammar</li>
<li>Teamwork- Willing to assist others when needed</li>
<li>Professionalism - Approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status and position. </li>
<li>Problem-Solving- Identifies and resolves problems in a timely manner; develops alternative solutions, maintains composure and a professional manner even when dealing with difficult situations</li>
<li>Commitment to Company Standards: Follows company procedures: demonstrates ethical behavior in all business dealings</li>
</ul>
Physical &amp; Mental Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The Company will provide reasonable accommodations to permit individuals with qualified disabilities to perform the essential functions of the position as may be required by law.
Reasoning &amp; Mental Abilities:
Uses critical thinking skills to interpret information furnished in written, verbal or schedule form. Makes sound decisions and sets goals based on available information and evaluates situations and requirements to plan and adjust work accordingly.
Projects accurate future occurrences based on current or historic data. Must be able to work independently and without direct supervision; able to make decisions about the severity of variable situations and evaluate the most appropriate response; able to make appropriate decisions related to customer requests.
Work Environment &amp; Exposures: 
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The Company will provide reasonable accommodations to permit individuals with qualified disabilities to perform the essential functions of the position as may be required by law. The noise level is quiet to low.

Patient Service Representative

<h3>Job Description</h3>
Job Description
Busy Ophthalmology medical practice currently seeking an enthusiastic patient service representative to join our team.
 
This could be a full or part-time position, requiring outstanding communication skills and attention to accuracy . Medical office experience is preferred. Responsibilities include, but are not limited to: Scheduling appointments, maintaining electronic records, verifying insurance eligibility, patient check-in/out, and collecting payments. Excellent benefit package offering healthcare insurance, dental, flex spending and other pretax benefit options.

<h3>Job Description</h3>
Job Description
Responsibilities
Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, we are Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of our success is its people with the commitment to a better healthcare experience. When you join usas a Patient Service Representative,you will be joining a dedicated team of professionals who deliver quality, value, and access in the 21st century and align all stakeholders- patients, providers, payors, and regulators to achieve the best clinical outcomes.
You Will:
<ul>
<li>Greet and register patients in a friendly and service-oriented manner.</li>
<li>Obtain or verify proper insurance and patient information, collect signatures and ensure accuracy and completion of necessary documentation.</li>
<li>Collect and log all co-pays and fees</li>
<li>Answer/transfer incoming phone calls.</li>
<li>Schedule, reschedule or cancel new or current patients, confirm appointments and notify staff of changes when necessary.</li>
<li>Give patients appropriate orientation for preparatory and safety protocols, and provide directions to facilities if needed.</li>
<li>Coordinate with the back-office staff for timely and effective care of patients</li>
<li>Demonstrates competency regarding the need to safeguard patient property and Patient Health Information.</li>
<li>Safeguards any on site medications in accordance with Company policies, procedures and any legal requirements.</li>
<li>Demonstrates respect for company property, including any cash and patient financial information on site or on patient portals.</li>
<li>Is responsive to the needs of others by exhibiting and maintaining professional behavior toward patients and coworkers.</li>
<li>Demonstrates respect for patient boundaries and cultural sensitivities during all interactions.</li>
<li>Demonstrates ability to interact diplomatically and sympathetically with patients, their families, and the public in a clinical setting.</li>
<li>Demonstrates ability to establish, nurture, and maintain cooperative working relationships.</li>
</ul>
You Are:
<ul>
<li>Genuinely passionate about customer service and exercise sound judgement and an ability to remain professional in all situations</li>
<li>Able to demonstrate effective and professional communication, interpersonal skills and respect with patients, guests &amp; colleagues</li>
<li>Able to thrive in a fast-paced environment, have a knack for prioritizing work with a structured approach, and enjoy providing world-class customer service</li>
</ul>
To Ensure Success In This Role, You Must Have:
<ul>
<li>High School Diploma or GED</li>
<li>Intermediate to advanced computer skills</li>
<li>Strong multitasking and communication skills</li>
<li>Experience providing exceptional customer service</li>
<li>Medical terminology knowledge and recent medical/radiology office experience is preferred.</li>
</ul>

We Offer: 
<ul>
<li>Comprehensive Medical, Dental and Vision coverages.</li>
<li>Health Savings Accounts with employer funding.</li>
<li>Wellness dollars</li>
<li>401(k) Employer Match</li>
<li>Free services at any of our imaging centers for you and your immediate family.</li>
</ul>

<h3>Job Description</h3>
Job Description

Patient Services Representative- Maternal Child Health- Per Diem
 
Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs.
 
The PSR is the first point of contact for patients, and their caregivers. Responsibilities include patient interviews, collecting and verifying demographic, insurance and financial data, accurately entering information into computer that affects any aspect of the registration, or admission, process. Excellent interpersonal skills, communication skills, accurate typing skills, knowledge of office procedures, and ability to work independently required. 
 
Roles and Responsibilities:
<ul>
<li>Patient Interaction and Support: Welcomes patients and caregivers warmly, provides support, and ensures proper patient identification using name and date of birth.</li>
<li>Registration and Documentation: Registers and pre-registers patients with accurate demographic and insurance details, scans identification and insurance documents, completes and explains required forms, and files imaging requisitions appropriately.</li>
<li>Admitting and Discharge Procedures: Adheres to admitting policies, ensures proper placement and transfer of patients per practitioner orders, and manages timely and accurate discharges.</li>
<li>Switchboard and Special Procedures: Covers switchboard during breaks and night shifts, handles deceased patients' procedures, and manages patient valuables in line with hospital policies.</li>
<li>Financial Transactions and Flexibility: Collects copays, follows cash handling protocols, and assumes additional responsibilities as needed to support hospital operations.</li>
</ul>
 
Required Skills and Experience:
<ul>
<li>High school education or equivalent experience</li>
<li>Two (2) years of clerical experience</li>
</ul>
 
Preferred Skills and Experience:
<ul>
<li>Previous healthcare experience</li>
<li>Knowledge of medical terminology </li>
</ul>
 
Physical Requirements:
<ul>
<li>Frequent hand and finger use (e.g., to operate a computer keyboard).</li>
<li>Lifting and carrying items up to 40 lbs. (e.g., boxes, equipment, IV solutions), with or without reasonable accommodation.</li>
<li>Ability to stoop, kneel, or crouch for tasks such as retrieving items from lower shelves or filing in low drawers.</li>
<li>Ability to sit, stand, or walk for extended periods, as the position may require (estimated 80% standing/20% sitting)</li>
<li>Capacity to operate job-related equipment, with or without reasonable accommodation.</li>
</ul>
 
Location, Travel and Shift Requirements:
<ul>
<li>Onsite: Cayuga Medical Center- 101 Dates Drive, Ithaca, NY 14850 </li>
<li>Shift: Schedule varies depending on department and staff needs; weekends and holidays as assigned.</li>
<li>0% Travel can be expected in this role</li>
</ul>
Pay Range Disclosure:
<ul>
<li>Standard Rate of $18.50 - $24.00 per hour</li>
</ul>
 
Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all. 
 
We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.
 
If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at <a href="mailto:talentacquisition@cayugahealth.org" target="_blank">talentacquisition@cayugahealth.org</a>.
 
 
I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added, or interpreted at any time, at the company's sole option and without prior notice to me.
I understand that any hiring decision is contingent upon my successful completion of all of the Company's lawful pre-employment/post-offer checks, which may include a background check, drug screen, employment references, and licensing review. If I am made a conditional offer of employment, I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment/post-offer checks. Such checks will not be conducted until allowed under applicable federal, state, and local law. I understand if I have a criminal background, it will not automatically disqualify me from employment unless otherwise required by law. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks.
I also understand that the Company is a drug and alcohol-free workplace and has a drug and alcohol testing program consistent with applicable federal, state, and local law. I understand that after a conditional offer of employment, I must submit to and pass a pre-employment drug test as a condition of employment.
 Job Posted by ApplicantPro

<h3>Job Description</h3>
Job Description
Olympic Sports &amp; Spine (OSS) is seeking a full-time proactive customer service-driven PSR to join our phenomenal Federal Way team. This is a full-time position working a minimum of 40 hours per week. The schedule would be 5x8 hour shifts working hours between 7:00am - 6:15 pm, Monday through Friday.
At OSS, we are committed to providing quality customer service and care to our patients and being a great employer to our employees. Our clinics are fun and full of supportive colleagues who all share an interest in creating the best possible place to work. In addition, we have an experienced staff that provides ample training and ongoing support.
QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
<ul>
<li>Knowledge of insurance and the verification process.</li>
<li>Knowledge of computer programs.</li>
<li>Knowledge of business office procedures.</li>
<li>Ability to operate a computer, scanner, fax/copy, and basic office equipment.</li>
<li>Ability to operate a multi-line telephone system.</li>
<li>Effective oral and written communication with patients, staff, insurers, and referral sources.</li>
<li>Ability to read, understand, and follow oral and written instructions.</li>
<li>Must be well organized, detail-oriented, and able to prioritize Tasks.</li>
</ul>
SUMMARY OF DUTIES:
Process all activity related to OSS's patient services. Patient service functions supported include phone calls, scheduling, insurance verification, follow-up, maintaining charts, filing, and communication with referral sources. Performs other daily operating functions associated with the front desk position. 
JOB RESPONSIBILITIES:
<ul>
<li>Manage all aspects of high-volume patient scheduling.</li>
<li>Receive incoming patient phone calls.</li>
<li>Collect necessary information from patients for treatment and billing purposes.</li>
<li>Verify insurance and obtain necessary authorizations if required.</li>
<li>Fax appropriate paperwork to referral sources.</li>
<li>Scan documents into the patient's account.</li>
<li>Build and maintain all patient charts.</li>
<li>Collect any money owed from patients, balance all money nightly, and print reports.</li>
<li>Maintain statistical log sheets daily to include all follow-ups.</li>
<li>Pull charts for the next day's appointments and make reminder calls.</li>
<li>Work on the patient issue listing and task list daily to resolve all issues.</li>
<li>Communicate with OSS staff through Outlook email.</li>
<li>Communicate closely with billing and treating staff to resolve all patient matters.</li>
<li>Open and sort mail daily.</li>
<li>Perform other related duties as required.</li>
<li>Participate in educational activities and attend monthly staff meetings.</li>
</ul>
BENEFITS: <a href="https://www.osstherapy.com/employee-benefits" target="_blank">https://www.osstherapy.com/employee-benefits</a>
Education/Experience:
High School graduation or equivalent AND two years of experience in an appropriately related position OR Equivalent education/experience.
Equal Opportunity Statement
We are an equal opportunity employer and value diversity at our company. We do not discriminate based on age, ancestry, citizenship, color, ethnicity, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or invisible disability status, political affiliation, veteran status, race, religion, or sexual orientation.
#OSS020
 
As part of our commitment to maintaining a professional, compliant, and high-integrity workplace, all employment offers at Olympic Sports &amp; Spine are contingent upon the successful completion of a comprehensive background screening. This process may include, but is not limited to, verification of prior employment and education, a credit check (if relevant to the position), criminal history review, and reference checks.
By submitting your application, you acknowledge and consent to this screening process. Please note that any offer of employment will remain conditional until the screening is complete and the results meet the standards set by Olympic Sports &amp; Spine.
Olympic Sports &amp; Spine is an equal opportunity employer and conducts all background screenings in compliance with applicable federal, state, and local laws.
 Job Posted by ApplicantPro

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