Claims Support Specialist
Sharp Healthcare - San Diego, CA

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Location:
This position is located in Kearny Mesa.

Hours:
8-hour shift: 8:00 am - 5:00 pm, weekends as needed.

Qualifications:
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Bachelor’s degree in data management preferred.
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Experience with database management and setup parameters for claims software applications required.
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Minimum three (3) years’ experience in HMO industry in the areas of claims, enrollment and customer service required.
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IDX software experience desirable.
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Knowledge of CPT, ICD, HCPCS and other health care coding systems required.
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Knowledge of health insurance or HMO operations with emphasis on software applications for claims processing, enrollment and customer service.
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Excellent organizational and interpersonal skills.
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Ability to effectively interact with management team.
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Ability to work with minimal supervision.
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Adept at being an initiator of positive change to support the Mission, Values, Goals and Objectives of Sharp Health Plan.
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Excellent analytical skills and understanding of data base management.
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Knowledge of word processing spreadsheet applications.

Summary:
Coordinate the set-up and maintenance of all Plan, payor and contract specific information to assure productive and accurate claims adjudication. Works independently and uses good judgment to prioritize department workflow. Participate in developing and implementing department’s goals, a system of continuous quality improvement, and audit techniques to assure data integrity, reliability and accuracy.

The Finance Division is responsible for the management of money and processing of reporting of information using a variety of different applications. The Finance Division includes may functional areas such as Accounting / Billing, Claims Research, Contracting, Data Analytics, Data and Information Systems and Underwriting / Actuarial.

Sharp Health Plan is San Diego’s only locally based commercial health plan. With a personal approach and a superior network of medical groups and physicians, Sharp Health Plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.

As one of the top-rated health plans in California (as measured by the CAHPS satisfaction survey), Sharp Health Plan serves a growing number of companies, large and small, in San Diego and southern Riverside counties.

Essential Physical Requirements may include:
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Sitting
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Lifting up to 10 pounds
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Push/Pull up to 10 pounds
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Carrying up to 10 pounds

Additional physical requirements of position may be discussed during interview.

Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer (M/F/D/V).

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.

Keywords: 51083, Claims Support Specialist

Sharp Healthcare - 19 months ago - save job - copy to clipboard - block
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About this company
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Sharp HealthCare stands on the cutting edge of health care delivery in Southern California. The system of not-for-profit hospitals and...