 Company Overview
Our Beginning
For more than 30 years SCAN Health Plan has been focusing on the unique needs of seniors. SCAN is a not-for-profit health plan dedicated to providing comprehensive medical coverage, prescription benefits and support services specifically designed to meet the needs of people on Medicare.
SCAN was founded in 1977 by a group of seniors who were frustrated by their lack of access to services and who wanted an organization that addressed their specific needs. These forward-thinking seniors formed the Senior Care Action Network, now known as SCAN Health Plan. The goal of the organization then was the same as it is today: to continue to find innovative ways to enhance seniors' ability to manage their health and to continue to control where and how they live. Since its inception, SCAN has provided the care needed to keep more than 25,000 seniors out of nursing homes. Today, SCAN is thriving and is one of the fastest growing health plans in the markets it serves.
Today
SCAN is based in Long Beach, California. The health plan has approximately 800 employees and serves close to 105,000 residents in Kern, Los Angeles, Orange, Riverside, San Bernardino San Diego and Ventura counties.
Also in Arizona, SCAN offers a health plan for Medicare and Medicaid-eligible individuals as part of the state's long term care program in Maricopa county.
SCAN also manages one of the largest and most successful Multi-Purpose Senior Service Projects (MSSP) in California. The MSSP provides community-based, long- term care and personal care coordination for low-income frail seniors. A similar program managed by SCAN, called Linkages, provides case management and community services to support independence for disabled adults.
The Future
SCAN is excited about expanding its mission to improve the lives of seniors through its benefit offerings and its overall expertise in senior health care. SCAN offers an innovative answer to the question of how to care for an increasing number of senior citizens. According to the U.S. Census, in 2001, 12.4% of the population was aged 65 and older. By 2030, however, people aged 65 and older are expected to make up 20% of the population. By expanding its membership and by maintaining its success, SCAN will meet its past, present and future goals: to provide the services necessary to help seniors maintain the best possible health while allowing them to remain independent.
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Job overview
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SCAN Health Plan
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 US-CA-Long Beach
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N/A
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Full-Time
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Healthcare - Health Services
Managed Care
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No
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Health Care
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High School
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Not Specified
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Not Specified
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Not Specified
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Not Available
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Not Available
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Send Email Now
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Not Available
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CES10509
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Job Description
Purpose: Processes contract and non-contract provider claims accurately and in a timely manner, meeting established Department and Company guidelines for quantity, turnaround time and accuracy.
Responsibilities:
Generates correspondence to request missing information necessary to complete claim payment and appropriate letters for denied claims. Determines level of reimbursement based on established criteria, provider contract or plan provisions. Denies all claims ineligible for payment. Enters coding information. Documents provider claims/system support payments and decisions. Identifies dual coverage, potential third party liability cases, and reinsurance/stop loss cases and requests additional information relevant to SCAN savings/recovery. Reviews claims for possible abuses of SCAN/delivery systems and brings issues to attention of management. Coordinates workflow with clerical support and other staff members.
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Job Requirements
Minimum 2 years claims processing experience in the health insurance industry or medical health care delivery system. Completion of health insurance training and medical terminology or equivalent knowledge through on-the-job training and experience. Knowledge of standard claims coding such as CPT4, ICD9, DRG and HCPCS. Knowledge of coordination of benefits and NAIC guidelines preferred. Ability to type 45-50 wpm and operate a 10 key in order to meet production goals. Knowledge of heath care benefit structures and insurance procedures, preferably as they exist in an HMO health care environment. Knowledge of an automated claims processing system and ability to use CRT. Intermediate to advanced expertise using Microsoft products such as Word, Excel and Access. Previous experience using an on-line claim payment system. Strong verbal and written communication skills.
Education:
High school graduate; 2 years college preferred.
SCAN is an Equal Opportunity Employer
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