Claims Processor
APR Consulting, Inc. has been engaged to identify a Claims Processor
Location: Santa Barbara, CA 93105
Position: Claims Processor
Pay Rate: $26.10/hr.
Duration: 13 Weeks
KNOWLEDGE, ABILITIES, AND SKILLS: This position will have a combination of education and experience to demonstrate competency in the methods, policies, procedures, regulations and protocols of a Claims function. Ability to communicate well with patients, families, co-workers, physicians, other members of the healthcare team, etc. Ability to adapt to varied, age-specific and/or specialized groups. Ability to understand use, function, interpret, document, and keep records. Ability to interpret, adapt and apply guidelines and procedures. Ability to react calmly and effectively in emergency situations. Ability to read, write and communicate effectively in English. Ability to
organize and prioritize work. Ability to follow oral and written instructions. Ability to reason and make sound judgments. Skill in identifying problems and recommending solutions. Skill in establishing and maintaining effective working relationships with co-workers, management, patients, medical staff, and the public. Skill in accepting constructive criticism and giving suggestions in a professional manner.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: (This list may not include all of the responsibilities assigned.)
1. Performs a spectrum of clerical chores that culminate in determinations for payment of claims to providers for authorized services rendered; specifically for HMO patients, encounter claims from PCP’s or capitated specialists, ancillary claims, emergency room, shared risk, anesthesia, eye exams claims, and Clinic specialty claims.
2. The processing involves making reasoned determinations as to eligibility for benefits, authorization of services rendered, financial responsibility for the costs incurred, verification of payment-amounts based on contractual agreements with providers, and fulfillment of co-payments or shared risk payments.
3. In addition, answers inquiries from patients, providers and HMO’s regarding status of claims, general payment, benefit, eligibility, and referrals.
4. This position has a direct influence upon both the financial condition of the organization and its’ reputation as a TPA (Third Party Administrator).
5. Maintains the strictest confidentiality in accordance with Sansum Clinic policy.
6. Provides exemplary customer service to patients and staff.
7. Completes special projects as assigned.
8. Works as a team player supporting a variety of staff.
9. Displays a caring and responsive attitude and conducts all activities respecting patient, family and employee rights and expectations.
10. Demonstrates sound cost containment techniques.
11. Adheres to established safety requirements and procedures to ensure a safe working environment.
12. Maintains and evaluates own clinical expertise and practice. Recognizes legal and policy limits of individual practice.
13. Maintains certification and license requirements and submits required evidence of certification/licensure as needed.
14. Adheres to all policies and procedures.
15. Completes annual performance and competency evaluation process with management and participates in goal setting, performance improvement and educational training as needed.
16. Participates in department quality improvement, clinic safety, infection control and hazardous materials programs/activities.
17. Participates in professional development activities and maintains professional affiliations.
18. Attends required meetings and participates in committees as requested.
19. Adheres to HIPAA regulations.
20. Exercises discretion and maintains high level of confidentiality.
21. Performs related work as required.
EDUCATION, EXPERIENCE AND LICENSURE:
- High School diploma or equivalent; some secondary (college) education desirable.
- This position requires familiarity with medical claims processing or insurance billing in a medical capacity.
Our client is one of the largest Healthcare Staffing Providers in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.
Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!
APR Consulting, Inc., is one of the most trusted talent acquisition and workforce solutions providers in the United States. Known for exceptional responsiveness, agile strategies, and consistently high-level talent, the firm has become a go-to for organizations and managed services providers navigating complex change and urgent challenges. Since its founding in 1980, APR has transformed from a California IT-focused staffing firm to a full-service solutions provider filling a wide range of positions and serving over eight industries — including aerospace and defense, healthcare, IT, telecom, hospitality/gaming, sports/entertainment, government, and utilities –– in all 50 states, with a loyal roster of more than 850 specialized professionals.