Job: Outside Claims Specialist RM - ENTRY LEVEL!

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Posted: 12/11/2017

Job Reference #: 2016-7483

Job Description

ID
2016-7483
# of Openings
1
Job Location
US-CA-San Diego
Posted Date
5/10/2016
Position Type
Regular Full-Time
FLSA Status
Non-Exempt
Featured Job
No

Opportunity Details:

About Us:

From coast to coast, Rural/Metro employees are tied together by their overwhelming desire to help others. Every day and every call for our team of highly-trained professionals is different than the one before.

At Rural/Metro, we celebrate the successes of our team members, and doing the right thing for those we serve.

Rural/Metro is a leader in private ambulance and fire protection services in 21 states and more than 700 communities nationwide. Rural/Metro has provided high-quality patient care, met and exceeded the expectations of the communities we serve, and invested in the success of our employees since 1948.

Overview:

The Outside Claims Specialist is responsible for the management, authorization, and processing of Outside Claims. Working under the Financial Manager, the Outside Claims Specialist ensures outside providers are reimbursed for covered transport services of contracted members.

Responsibilities:

Administrative Functions

  • Complies with contractual stipulations and requirements with regards to the payment of all outside claims.
  • Works with contracted providers and health plans to verify proper insurance and validity of transport.
  • Reviews claims from contracted providers to determine level of payment, validity of service and medical necessity of transport.
  • Maintains the outside claims database tracking of claims and payment in compliance with contractual requirements.
  • Works with the Financial Manager to create reports regarding payments of outside claims, provides monthly flash accountability and monthly reports for contracts.
  • Processes and sends denials and claims acknowledgements as appropriate.
  • Maintains positive relationships with contracted providers and health plans.
  • Supervises the Outside Claims Clerk to ensure proper processing of invoices and posting of paid invoices.


Training

  • Attend all Company required OSHA and Compliance training, annual training, and all mandatory Company updates. Complete the training in the allotted time the Company sets.
  • Maintain knowledge of job and medical field.
  • Keep current on training for new equipment, procedures, and techniques.
Qualifications:

  • NO experience required.
  • Strong Microsoft Office experience with emphasis on Excel.
  • Exhibit high degree of social, ethical, and organizational norms.
  • Maintain a stable disposition despite external pressure and opposition
  • Excellent Customer Service (for internal and external customers)
  • Exceptional attention to detail
  • Ability to maintain confidentiality
Educational Requirements:
  • High school diploma or GED required.
Closing Statement:

Rural/Metro Corporation is proud to be an affirmative action / equal opportunity employer. All qualified applicants will receive consideration without regard to race, creed, gender, marital status, sexual orientation, citizenship status, color, religion, national origin, age, disability, veteran status, or any other status protected under local, state or federal laws.

Application Instructions

To apply, click the link below.

Apply now with Rural Metro