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Lead Claims Processing

Send to my Email Email a friend Job ID 75209 Date posted 08/03/2016
Requisition ID: 75209
  • Facility: Sharp HealthPlan
  • City: San Diego
  • Department: Finance
  • Category: Business Operations Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: 8 AM
  • Shift End Time: 5 PM
This position is located in Kearny Mesa, San Diego County. 
8-hour shift: 8:00 am – 5:00 pm, Weekends as needed.
Required Skills and Qualifications
  • High School Diploma
  • Minimum 8 years of experience in the healthcare industry or a Managed Care environment (HMO, Medicare, Covered California, Medi-Cal) with demonstrated performance that consistently exceeds expectations.  Experience and knowledge of on-line claims systems
  • Excellent organizational, time management skills and ability to multitask
  • Proven knowledge of benefits, covered and non-covered services, Provider Dispute Resolution process, billing, and reimbursement procedures for HMO's/medical groups
  • Proven knowledge of ICD-9/ICD-10 codes, CPT, HCPCS, RBRVS, DRG's, UB04, and CMS-1500 claim formats and medical terminology
  • Ability to prepare monthly, quarterly and annual timeliness reports for submission to Sharp Health Plan’s Regulatory Department and Department of Managed Health Care. 
  • Demonstrated leadership and experience in motivating and developing staff.
 Preferred Skills and Qualifications
  • Bachelor’s degree in business or related field or equivalent knowledge/experience in related field preferred
  • Certified Coder preferred

The Lead schedules, oversees and monitors the day to day activities of the Claims Unit. This position provides personnel in the assigned area with training, communication, and leadership for the purpose of ensuring that staff individually and as a team meet and exceed department performance standards. In the absence of, or as directed by the Claims Manager, this position acts in a direct management capacity.
Sharp Health Plan is the largest locally based commercial health plan in San Diego. We are a not-for-profit health plan that has been serving San Diego and southern Riverside Counties since 1992. As a subsidiary of Sharp HealthCare, we are backed by the largest provider of comprehensive health care services in San Diego.
Sharp Health Plan offers a variety of coverage options that combine affordability and choice, while delivering high quality health care and personal service. We provide health insurance for companies of all sizes throughout the region. Members have access to valuable plan enhancements, such as interactive wellness resources, dental discounts and our exclusive global emergency services program. 
Essential Physical Requirements may include
  • Sitting
  • Keyboarding
  • Mousing
  • Lift up to 10 pounds
  • Push/pull up to 10 pounds
  • Carry 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.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.
Keywords: Claims, Auditor, Certified Professional Coder
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