Top 26 Resolution coordinator Jobs in Fairfield, Ca

Claims Resolution Coordinator
Partnership HealthPlan of California —Fairfield, CA
- $37.22 - $46.53 an hour
- Full-time
- Computer literacy
- Mid-level
- Office
First Legal Coordinator
First Legal Network LLC —Fairfield, CA
- $40,000 - $70,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Service Coordinator
FPM - Affordable Housing —Vacaville, CA
- $25 an hour
- Urgently hiring
- Microsoft Outlook
- Experience working with individuals with disabilities
- Writing skills
- Paid holidays
- Health insurance
Quick Apply
Social Service Coordinator
CCH —Napa, CA
- $25.50 - $30.29 an hour
- Full-time
- Background check
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Assessment Coordinator I
Turning Point Community Programs —Fairfield, CA
- $24.00 - $24.97 an hour
- On call
- Psychiatry
- Computer literacy
- Adults
Quick Apply
Administrative Coordinator
Alba Wheels Up International —Napa, CA
- $23.56 - $31.25 an hour
- Spanish
- Writing skills
- ERP systems
Quick Apply
Client Support Coordinator
Turning Point Community Programs —Fairfield, CA
- $23 an hour
- Mid-level
- High school diploma or GED
- Driver's License
Quick Apply
Inventory Control Coordinator, 2nd Shift
Ferrara Candy Company, Inc. —Fairfield, CA
- $25 an hour
- Overtime
- Mid-level
- Analysis skills
- Continuous improvement
- Health insurance
- Paid time off
Clinisys Sunquest LIS Application Coordinator 6403728
Accenture —Walnut Creek, CA
- $45 - $50 an hour
- Full-time
- Remote
- HIPAA
- Mid-level
- High school diploma or GED
- Disability insurance
- Health insurance
3d
START Coordinator (Mental Health Crisis Worker)
Turning Point Community Programs —Fairfield, CA
- $34.00 - $36.80 an hour
- On call
- Spanish
- Skilled nursing facility
- English
Quick Apply
Procurement Coordinator
PBF Energy —Martinez, CA
- $88,424.81 - $156,910.67 a year
- Microsoft Excel
- Microsoft Outlook
- Marketing
- Health insurance
- Paid time off
Outreach Coordinator, Academic Talent Search (Student Services Professional III), Fixed-Term
California State University —Sonoma, CA
- Email
- Background check
- Spanish
- Microsoft Excel
- Paid holidays
- Health insurance
Client Relations Coordinator
Benchmark Wine Group —Napa, CA
- $20 an hour
- 8 hour shift
- Microsoft Excel
- Microsoft Outlook
- Office
- Paid holidays
- Health insurance
Quick Apply
3d
Outreach Coordinator, Upward Bound Piner (Student Services Professional III), Fixed-Term
California State University —Sonoma, CA
- Email
- Background check
- Spanish
- Microsoft Excel
- Paid holidays
- Health insurance
Recruiting Coordinator - Home Care
All Ways Caring HomeCare —Concord, CA
- $21 an hour
- Full-time
- Background check
- Mid-level
- Administrative experience
- 401(k)
- Tuition reimbursement
Risk and DOT Compliance Coordinator
VinLux —American Canyon, CA
- $70,304 - $103,818 a year
- Full-time
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Disability insurance
Quick Apply
Merchandise Coordinator (Creative Services) - Pottery Barn Teen
Williams-Sonoma, Inc. —Richmond, CA
- $29 - $31 an hour
- Microsoft Outlook
- Bachelor of Science
- Merchandising
- Wellness program
- Commuter assistance
Bilingual Customer Service Coordinator
24 Hour Home Care - Corporate Division —Concord, CA
- $21.00 - $23.89 an hour
- Hybrid work
- Spanish
- Microsoft Excel
- Microsoft Outlook
Quick Apply
4d
Merchandise Coordinator, Creative Services - Pottery Barn
Williams-Sonoma, Inc. —Richmond, CA
- $26 - $30 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Bachelor of Science
- Wellness program
- Commuter assistance
10d
Facilities Coordinator
CCH —Walnut Creek, CA
- $70,304 - $92,600 a year
- Full-time
- Carpentry
- Word processing
- Writing skills
- Health insurance
- Dental insurance
8d

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Claims Resolution Coordinator

Partnership HealthPlan of California -
Fairfield, CA

Apply Now

Job Details

Full-time
$37.22 - $46.53 an hour

Qualifications

ICD-9
Driver's License
Typing

Full Job Description

Overview:

To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected Partnership managers. Develops and maintains provider training materials for all lines of business. Conducts provider trainings across Partnership departmental lines in group or individual provider settings.

Responsibilities:

Answers customer service lines as necessary and responds to provider inquiries either by phone, email, or in person regarding claims related questions.
Reviews, researches, and works with various departments to resolve complex provider inquiries, appeals, and grievances.
Acts as a resource and provides support to customer service staff, as well as Provider Relations staff for complex Provider questions regarding claims and payments.
Coordinates with Claims, Member Services, Health Services departments, the development, maintenance, and training of ongoing educational materials and tips for inclusion on the PHC website. Incorporates educational materials into the PR Manual and update on a quarterly basis.
Processes CIF's and adjustments as needed.
Writes and runs reports in Business Objects to obtain needed claim data.
Tracks and analyzes provider trends with denials and CIF's to provide support to providers with an opportunity to improve. Distributes provider scorecards.
Tracks complaints, appeals, and grievances by program. Reports activities on a quarterly basis to IQI, PHC Compliance Coordinator, and Claims Director.
Presents findings and recommendations for ongoing, long term resolutions to issues. Identifies items to address the “provider hassle factor.”
Acts as liaison and meets with designated staff from Claims, Health Services, Member Services, and QI departments to identify ongoing provider issues.
Coordinates system issues with Claims Configuration staff, IT staff, and PR Lead Project Specialist/Auditor. Leads or participates in special projects as needed.
Other duties as assigned

Qualifications:

Education and Experience

Minimum 1 year of experience in claims examining or customer service within healthcare, insurance, finance, or managed care environment; or equivalent combination of relevant experience and education.

Special Skills, Licenses and Certifications

Familiarity with Medi-Cal and/or managed care claims processing. Knowledge of CPT, HCPC procedure coding, and ICD-9 diagnostic coding. Knowledge of Partnership Claim Policy and Procedures, Medi-Cal provider manual guidelines, Title 22 regulations and any other required policies, procedures, regulations, and manuals. Typing speed 30 wpm and proficient use of 10-key calculator. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business .

Performance Based Competencies

Ability to analyze and research claims issues. Excellent written and oral communication skills. Ability to present statistical and technical data in a clear and understandable manner. Good organization skills. Ability to work on multiple assignments simultaneously, prioritize work and complete projects within established time frames. Use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 60% of work time is spent in front of a computer monitor. When required, ability to move, carry or list objects of varying size, weighing up to 5 lbs.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 37.22 - $ 46.53

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Apply Now

Refine Your Search

resolution coordinator jobs in fairfield, ca

Claims Resolution Coordinator

First Legal Coordinator

Service Coordinator

Social Service Coordinator

Assessment Coordinator I

Administrative Coordinator

Client Support Coordinator

Inventory Control Coordinator, 2nd Shift

Clinisys Sunquest LIS Application Coordinator 6403728

START Coordinator (Mental Health Crisis Worker)

Procurement Coordinator

Outreach Coordinator, Academic Talent Search (Student Services Professional III), Fixed-Term

Client Relations Coordinator

Outreach Coordinator, Upward Bound Piner (Student Services Professional III), Fixed-Term

Recruiting Coordinator - Home Care

Risk and DOT Compliance Coordinator

Merchandise Coordinator (Creative Services) - Pottery Barn Teen

Bilingual Customer Service Coordinator

Merchandise Coordinator, Creative Services - Pottery Barn

Facilities Coordinator

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