ACCESS REPRESENTATIVE III - Claims in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 7/4/2018

Job Snapshot

Job Description

Responsible for auditing and analyzing claims payment for Scripps Clinic Health Plan Services. To develop solutions and complete any action necessary to resolve inappropriate coding or payment practices. To analyze data and provide training to Account Representatives I and II ensuring compliance with all regulatory agencies and internal policy and procedures.

Job Requirements

Required Education/Experience/Specialized Skills: 2 or more years processing facility or professional claims experience and; ability to process claims in an efficient and accurate manner; understanding of HMO and provider contracts. Knowledge of Government and non-Government insurance regulations and billing practices including CPT and ICD9 Coding; understanding of basic Medical Terminology. Knowledge of the Department of Managed Healthcare regulations. Ability to interpret laws regulations and identify and propose policy and procedure changes as needed. Good verbal, written communication and interpersonal skills. Health Plan and CMS or related auditing experience.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.