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CLAIMS PROCESSOR SR in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 5/10/2019

Job Snapshot

Job Description

At Scripps Health, you will experience the pride, support and respect of an organization that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.

You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.
As a nationally recognized health system, Scripps Health is committed to providing the highest quality care to our patients. Bring your valuable talents to our Financial Services team as a Senior Claims Processor.  Our Financial Services Teams boasts a spirit of continuous improvement and a commitment to making a difference in the lives of our patients.  Looking for an individual who has strong written and communication skills and is looking to join a close knit, outgoing team who relies on each other daily as the work in a team focused environment.  
As the Senior Claims Processor you will be responsible for instructing, auditing, directing, analyzing and checking the work of other claims processors. You will determine whether to return, deny, or pay claims following organizational policies and procedures. Provide guidance or expertise to less experienced claims processors and the offshore team. Handle escalated and unresolved claims including audit preparation. The position shall support all claims payment recovery functions, Provider Dispute Resolutions, collections, oversight of Coordination of Benefits (COB) functions as well as Third Party Liability (TPL) activities. Ensures compliance and turnaround times are consistently being met or exceeded by working applicable assignment and ensuring the release of claims inventory.  Assist in the recovery of overpayments by researching paid claims; answering inquiries; and interacting with other departments, insurance adjustors, attorneys, and member. 
This is a Full Time, 8 Hour Monday – Friday Day position, located at our 4S Ranch/Rancho Bernardo Business Services office. 

Job Requirements

Required Education/Experience/Specialized Skills:
  • High School Diploma or equivalent 5 years of professional or facility claims processing.
  • Working knowledge of medical terminology and RVS/CPT/ICD-9/ICD-10 coding.
  • Knowledge of standard insurance procedures (pricing, exclusions, etc.)
  • Efficient organization skills, ability to multi-task, proficient in ten key by touch, excellent verbal and written communication skills.
  • Strong computer skills, highly analytical and ability to train all level of professionals.

Preferred Education/Experience/Specialized Skills/Certification:
  • Some College preferred and/or CPC certification
  • Knowledge of CMS and Commercial Provider Dispute Regulations.

Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, only San Diego-based company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with disability.