General Description. Under close supervision, the Claims Examiner will perform the accurate review, entry and processing of all claims received for payment by HPSM. . Essential Functions. Research rejected claims as necessary and re-adjudicate when resolved. Correspond as required to resolve rejected claims. Review reports, verifying accurate data and making corrections as appropriate. Review less complex edits to determine the appropriate handli...
Responsible for engaging with internal and external stakeholders to develop, manage, and improve Enhanced Care Management and Community Supports programs related to HPSM’s members under CalAIM. The Program Manager will have a focus on the Justice Involved and Birth Equity Populations of Focus providing operational support and relationship management for ongoing contracted, provider and vendor delivered programs with a focus on quality, accessibil...
General Description. Under the general direction of the Director of Provider Services, the Provider Services Regulatory Program Manager develops, manages, and improves Provider Services (PS) regulatory and accreditation efforts (e.g. DHCS, DMHC, CMS, and NCQA). The PS Regulatory Program Manager serves as a subject matter expert, coordinates the submission of deliverables, authors regulatory reports and acts as a liaison across internal departmen...
HPSM seeks a dedicated, experienced Systems Administrator to join our innovative IT team. If you’re passionate about maintaining network infrastructure, ensuring seamless systems operations, optimizing performance, troubleshooting complicated problems and implementing cutting-edge solutions, then we want to hear from you. A hybrid work option is available for California residents (that is, you must be able to work onsite at least part of the week...
Do you speak English and Tagalog fluently. You can help HSPM members with limited English proficiency get the most out of their health care benefits by joining our Member Services team. You’ll provide helpful customer service to people over the phone. Plus, you can work part of the time from home because a hybrid work option is available for California residents. (But you must be able to work onsite at least part of the week.) This position is no...
Do you speak English and Spanish fluently. You can help HSPM members with limited English proficiency get the most out of their health care benefits by joining our Member Services team. You’ll provide helpful customer service to people over the phone. Plus, you can work part of the time from home because a hybrid work option is available for California residents. (But you must be able to work onsite at least part of the week.) This position is no...
As a liaison between business and IT teams, this role ensures cost-effective solutions. Responsibilities include process analysis, project management, test script development, documentation, vendor management, and data analysis. Position is not eligible for sponsorship. . Position overview. Improving organizational and staff performance by analyzing/developing workflows, processes, and functional gaps and developing optimal solutions. Serving as ...
As a bilingual Behavioral Health Care Management Specialist, you will serve as a member liaison, providing vital assistance with care management for HPSM members with behavioral health treatment needs. Your primary focus will be on responding to requests for behavioral health provider matching and guiding members receiving behavioral health care, ensuring they are linked to appropriate providers. You will collaborate closely with provider service...
Under the general direction of the Government and Regulatory Affairs Manager, conduct internal and external audits that are routine and complex. Act as a subject matter expert resource to HPSM staff by providing a comprehensive explanation and interpretation of regulations and applicability to audits and audit findings. Essential Functions. Independently create and maintain auditing tools in accordance with standards and regulations established b...
CareAdvantage Program Manager I. Responsible for program development, integration, and execution in support of departmental processes, operations, and administrative efficiency for the CareAdvantage department. Responsible for engaging with internal and external stakeholders to develop, manage, and improve programs related to HPSM’s CareAdvantage members. The Program Manager provides operational support and relationship management for ongoing con...
The Health Information Management Data Analyst plays a crucial role in supporting the Health Information Management Department's mission. This position offers a unique opportunity to contribute to the acquisition, analysis, and utilization of health information and data. That drives improved outcomes for our members, greater engagement with providers and enhanced data analytics strategies. A remote work option is available for California resident...
Are you a compassionate professional based in California, eager to help the community and be part of an innovative and energetic team. Health Plan of San Mateo (HPSM) is seeking a Systems Administrator to join our dynamic organization. If you have extensive knowledge and expertise in Cisco networking and VMware infrastructure and are passionate about making a difference in the lives of others, this position offers a unique opportunity to be a key...
