Company Name   

                                              Contact                

                                              Phone     Fax      Email 

                                               Assignment Location 

                                              City     State Zip 

                                              Report To     Title    Phone 

                                              Description of Work:

                                              Position    Pay Rate    Number of Positions Open

                                              Functions (please check all that apply)

                                            Registration        Appointment Scheduling      Charge Entry       Claim Submission  

                                            Payment Posting   A/R Follow Up       Self Pay Collections           Coding   

                                            Claims Processing Customer Service

                                              Other Duties / Requirements: 

               

                                               Computer System(s) Used       

                                               Training Available on Computer System? Yes    No

                                               Duration  Temporary     Temp-to-Hire     Direct Hire

                                               Start Date    End Date 

                                               Days Per Week  Monday       Tuesday      Wednesday       Thursday 

                                                                        Friday         Saturday     Sunday    

                                                Hours to

                                                Dress Code 

                                                 Additional Comments: