This is a full-time leadership position, eligible for Scripps Health annual Management Incentive Compensation Plan. This position is partial remote and located in San Diego and does require residence in San Diego. The weekly schedule will be 2 days in the office and 3 days remote.
Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide.
Why join Scripps Health?
AWARD-WINNING WORKPLACE:
- #5 in Fortune Best Workplaces in Health Care 2023
- #78 in 2023 PEOPLE Companies that Care
- #95 in Fortune 100 Best Companies to Work for 2023
- Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024
- Nearly a quarter of our employees have been with Scripps Health for over 10 years.
The Director, Payment Services ensures accurate and timely payment of provider claims. Successful Plan and DMHC Audit performance. Staff education and training. Manages PDR process. Interfaces with all MSO and Plan departments to ensure proper workflow. Serves as subject knowledge expert for IS implementations and reporting.
Other job duties include:
- Institutional and professional claims, implications and codes.
- DMHC audits, health plan audits, and CPT and ENM coding.
- Experience with mailroom.
- Working with Epic workbench and WebI reporting and Epic Tapestry.
Qualifications
Required Education/Experience/Specialized Skills:
- Bachelor's Degree plus 5 years' experience in managed care claims leadership.
- Expertise in California DMHC claims regulations, NCQA regulations, and health Plan experience.
- Strong technical aptitude for computer systems and databases.
Preferred Education/Experience/Specialized Skills/Certification:
- Master's degree in a related field.
- Epic Tapestry experience.
- Strong reporting experience, specifically Epic Workbench and WebI.
- Understanding of institutional and professional claims, implications and codes.
- Experience with DMHC audits, health plan audits, CPT and ENM coding.
- Mailroom experience.