Job Description

Job #2631: Healthcare

Job Code:#2631

Title:Claims Processor II

Job Type:Contract

Job Location:San Diego

CA

Job Description:

ABOUT US

Global Service Resources, Inc.,a leading Healthcare staffing company has opening’s for Claims Processor IIat our local government client location: Rady Children’s Hospital.

JOB DESCRIPTION

Department: CHOC Administration Location- Copely

Schedule: M-F 8:00 a.m. -5:00 p.m. Duration: 13 weeks, possible extension

+ The primary purpose of this Claims Processor II position is to examine and process claims from the UB04 and CMS-1500 claim forms into the claims adjudication system for all capitated and shared services accounts.

+ This position is responsible for the accurate review, input and adjudication of claims using reasonable payment policies and methodologies that are consistent with and recognized by Health Plans, nationally recognized medical organizations, federal regulatory bodies, and contractual obligations of the organization.

+ Provide expertise and/or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims

+ Authorize appropriate payment or refer claims for further investigation as appropriate

+ Analyze and identify trends

+ Consistently meet established productivity schedule, adherence, and quality standards

+ Process priority and special claims requests • Process claims adjustments and/or appeals

REQUIREMENTS

+ Minimum Qualifications: High School Diploma, GED or foreign equivalent;

+ 2 year experience required

+ Preferred Qualifications: High School Diploma, GED or foreign equivalent;

+ 3 year experience required.

+ Preferred knowledge of CMS-1500 and UB04 claim form types

+ Familiar with CPT, HCPC, ICD-10/ICD-9 coding structures, and Medi-cal Managed Care.

BENEFITS

At Global Service Resources Healthcare,we concentrate on building careers and we offer attractive compensation packages.

+ Medical Insurance

+ Vision Insurance

+ Prescription Drug Card Coverage

+ Paid Private Housing or Housing Stipend

+ Paid Travel Allowance

+ Mileage Reimbursement

+ 401(K) savings plan with employer match (soon to come)

+ Hours Bonus

+ Referral Bonus Program

+ Free Direct Deposit

+ Paid Professional Liability insurance

+ Paid training

+ Continuing Education assistance

*Benefits available according to company policy

References will be requested if called for an interview.

Since the job needs to be filled immediately please email your resume as soon as possible.

We will contact you on receipt!

Thank you,

Global Service Resources, Inc.