Operation CIF Specialist - Roseville, CA - Hybrid
Gainwell Technologies
- Roseville, CA
- $50,300-71,900 per year
- Permanent
- Full-time
- Process Claim Inquiry Form (CIF), monitor system edits and history cross-check functionality, resolve dental procedure edits, and verify the appropriateness of proposed treatments according to the California Medi-Cal Dental program guidelines.
- Research and evaluate the status of Claims submitted for payment and process reevaluation requests for denials or modification of original requested services.
- Analyzes and evaluates both production and processing output results to identify errors and inconsistencies.
- Works with and consults with leadership and clients to review and evaluate inconsistent and erroneous output results.
- Evaluate program policy changes and identify potential adverse impact(s) on systems and operations.
- Two years of college preferred or equivalent combination of education and experience.
- Analytical skills necessary to effectively evaluate operations test results.
- Ability to communicate effectively, both orally and in writing, and work cooperatively with others; ability to work independently as well as collaboratively.
- Two years of full-time experience supporting Claim Inquiry Forms (CIF) on the Medi-Cal Dental program in California.
- Ability to maintain confidentiality.
- Must be a resident of the state of California.
- Hybrid work environment 3 days a week in the office as needed for face-to-face and client meetings with the remainder of the time remote work.
- The office is located in Roseville, CA.