Claims Processor - Santa Barbara, United States - Sansum Clinic

Description

Job Description

The Claims Processor ensures efficient claims processing for services provided. They perform 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. 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. In addition, they answer inquiries from patients, providers and HMO's regarding status of claims, general payment, benefit, eligibility, and referrals.

Required Skills & Qualifications:

• High School diploma or equivalent
• Familiarity with medical claims processing or insurance billing in a medical capacity

Preferred Skills & Qualifications:

• Some secondary education