Mortgage Loan Processor jobs in Santa Barbara, CA

AJ01

Job Title: Claims Processor

Location: Santa Barbara, CA

Duration: 13 Weeks Contract

Pay Rate: $20-25/hr.Shift: 5, 8Hr 08:00 - 17:00

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

1. Performs 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, anaesthesia, eye exams claims, and Clinic specialty claims.
2. 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 fulfilment of co-payments or shared risk payments.
3. In addition, answers inquiries from patients, providers and HMO’s regarding status of claims, general payment, benefit, eligibility, and referrals.
4. This position has a direct influence upon both the financial condition of the organization and its’ reputation as a TPA (Third Party Administrator).
5. Maintains the strictest confidentiality in accordance with Sansum Clinic policy.
6. Provides exemplary customer service to patients and staff.
7. Completes special projects as assigned.
8. Works as a team player supporting a variety of staff.
9. Displays a caring and responsive attitude and conducts all activities respecting patient, family and employee rights and expectations.
10. Demonstrates sound cost containment techniques.
11. Adheres to established safety requirements and procedures to ensure a safe working environment.
12. Maintains and evaluates own clinical expertise and practice. Recognizes legal and policy limits of individual practice.
13. Maintains certification and license requirements and submits required evidence of certification/licensure as needed.
14. Adheres to all policies and procedures.
15. Completes annual performance and competency evaluation process with management and participates in goal setting, performance improvement and educational training as needed.
16. Participates in department quality improvement, clinic safety, infection control and hazardous materials programs/activities.
17. Participates in professional development activities and maintains professional affiliations.
18. Attends required meetings and participates in committees as requested.
19. Adheres to HIPAA regulations.
20. Exercises discretion and maintains high level of confidentiality.
21. Performs related work as required.

Required Skills:

• This position will have a combination of education and experience to demonstrate competency in the methods, policies, procedures, regulations and protocols of a Claims function.
• Ability to communicate well with patients, families, co-workers, physicians, other members of the healthcare team, etc.
• Ability to adapt to varied, age-specific and/or specialized groups.
• Ability to understand use, function, interpret, document, and keep records.
• Ability to interpret, adapt and apply guidelines and procedures.
• Ability to react calmly and effectively in emergency situations.
• Ability to read, write and communicate effectively in English.
• Ability to organize and prioritize work.
• Ability to follow oral and written instructions.
• Ability to reason and make sound judgments.
• Skill in identifying problems and recommending solutions.
• Skill in establishing and maintaining effective working relationships with co-workers, management, patients, medical staff, and the public.
• Skill in accepting constructive criticism and giving suggestions in a professional manner.
• High School diploma or equivalent; some secondary (college) education desirable.
• This position requires familiarity with medical claims processing or insurance billing in a medical capacity.
• As a Sansum Clinic employee, the Claims Processor commits to uphold and contribute to the WE CARE culture, serving, communicating and caring wholeheartedly for our patients and colleagues during every encounter, every time.
• As a Sansum Clinic employee, the Claims Processor commits to: Welcome warmly and sincerely
• Engage wholeheartedly
• Communicate the plan

Job Type: Contract

Salary: $20.00 - $25.00 per hour

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• In-person

Experience:

• Medical claims: 1 year (Required)
• Medical billing: 1 year (Required)

Ability to Relocate:

• Santa Barbara, CA: Relocate before starting work (Required)

Work Location: In person