Cencal Health
Job Details
Job Location Main Office - Santa Barbara, CA
Remote Type Fully Remote
Position Type Full Time
Salary Range $28.80 - $39.47 Hourly
Job Category Claims
Job Posting Date(s)
Start Date 09/08/2025
Description
Central Coast Salary Range:
$28.20 - $37.49
While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.
Job Summary
This position is responsible for responding to CenCal Health Provider telephone inquiries regarding the D-SNP CareConnect Claims, researching and responding to the D-SNP claims issues raised, performing regular monthly meetings with the provider community, assisting with provider workshops preparing educational materials and providing suggestions for the Claims Bulletin and EOB inserts (fliers) when necessary; research and resolve provider disputes, higher level reviews and stay current with all CenCal Health policies and procedures.
Duties and Responsibilities
Intake and respond to all provider telephone inquiries Log all calls received and initiated into the Provider Call Tracking system within QNXT and maintain accurate accounts of conversations within the log for tracking purposes Research, adjudicate and respond to all claims issues related to telephone inquiries, disputes, NCM and provider emails in a timely manner Send provider EOP's when requested Review test Explanation of Payment (EOP's) for accuracy of claims payment, denials and suspends Monitor provider billing errors, trends and provide courtesy calls to providers, when possible, problems or trends are detected Assist with pended claims when necessary Conduct meetings with Providers that are experiencing a high volume of denials, that have new billers, or any provider requesting assistance with any type of claim related issues. Compose letters to those providers visited. Conduct and outline discussions during the meeting and perform any follow up that may have been required Analyze provider's claims to assure the most accurate, timely and efficient processes are occurring and work directly with the providers where improvement may be needed In conjunction with the Claims Service Supervisor, prepare and occasionally present at the Claims Provider Workshops Complete special projects within the department when necessary Complete processes and timelines required by CMS, AB1455, and DHCS Regulations Other duties as assigned Qualifications
Knowledge/Skills/Abilities
Excellent customer service skills Strong oral and written communication skills (including the ability to speak in front of an audience) Excellent attention to detail Demonstrated ability to perform special claims projects Knowledge of CenCal Health and the Medicare D-SNP program is strongly preferred QNXT experience - (Required) Strong knowledge of the D-SNP program (Required) Strong knowledge in dual eligible claims processing (Medi-Cal and Medicare D-SNP) Education and Experience
Required:
High school diploma or equivalent Preferred one (1) year of claims processing experience and/or minimum of 3 months. Equivalent medical billing background a plus.
Job Location Main Office - Santa Barbara, CA
Remote Type Fully Remote
Position Type Full Time
Salary Range $28.80 - $39.47 Hourly
Job Category Claims
Job Posting Date(s)
Start Date 09/08/2025
Description
Central Coast Salary Range:
$28.20 - $37.49
While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.
Job Summary
This position is responsible for responding to CenCal Health Provider telephone inquiries regarding the D-SNP CareConnect Claims, researching and responding to the D-SNP claims issues raised, performing regular monthly meetings with the provider community, assisting with provider workshops preparing educational materials and providing suggestions for the Claims Bulletin and EOB inserts (fliers) when necessary; research and resolve provider disputes, higher level reviews and stay current with all CenCal Health policies and procedures.
Duties and Responsibilities
Intake and respond to all provider telephone inquiries Log all calls received and initiated into the Provider Call Tracking system within QNXT and maintain accurate accounts of conversations within the log for tracking purposes Research, adjudicate and respond to all claims issues related to telephone inquiries, disputes, NCM and provider emails in a timely manner Send provider EOP's when requested Review test Explanation of Payment (EOP's) for accuracy of claims payment, denials and suspends Monitor provider billing errors, trends and provide courtesy calls to providers, when possible, problems or trends are detected Assist with pended claims when necessary Conduct meetings with Providers that are experiencing a high volume of denials, that have new billers, or any provider requesting assistance with any type of claim related issues. Compose letters to those providers visited. Conduct and outline discussions during the meeting and perform any follow up that may have been required Analyze provider's claims to assure the most accurate, timely and efficient processes are occurring and work directly with the providers where improvement may be needed In conjunction with the Claims Service Supervisor, prepare and occasionally present at the Claims Provider Workshops Complete special projects within the department when necessary Complete processes and timelines required by CMS, AB1455, and DHCS Regulations Other duties as assigned Qualifications
Knowledge/Skills/Abilities
Excellent customer service skills Strong oral and written communication skills (including the ability to speak in front of an audience) Excellent attention to detail Demonstrated ability to perform special claims projects Knowledge of CenCal Health and the Medicare D-SNP program is strongly preferred QNXT experience - (Required) Strong knowledge of the D-SNP program (Required) Strong knowledge in dual eligible claims processing (Medi-Cal and Medicare D-SNP) Education and Experience
Required:
High school diploma or equivalent Preferred one (1) year of claims processing experience and/or minimum of 3 months. Equivalent medical billing background a plus.