We are seeking a dedicated and detail-oriented Medical Claims Specialist to join our team. The ideal candidate will be responsible for managing the claim follow-up process to ensure accuracy, efficiency, and compliance with healthcare regulations. You will work closely with patients, insurance companies, and internal teams to resolve discrepancies and ensure timely payment of services.
Key Responsibilities:
Accurately review and respond to payment rejections and denials to ensure claims are processed correctly.
Develop and submit customized appeals to insurance companies to avoid denials and ensure maximum reimbursement.
Manage and fulfill requests for medical records from payers in a timely and accurate manner.
Collaborate with patients or customers, third-party institutions, and other team members to identify and resolve billing inconsistencies and errors
Accurately post payments received from payers and patients to appropriate claims in the billing system.
Ensure patients are informed about their billing details and provide assistance to help them understand their statements and payment obligations.
Maintain accurate and up-to-date financial records for each patient account involving payment history, upcoming payment information, or other financial data.
Qualifications:
High school diploma or equivalent (required); Associate's degree in healthcare administration or related field (preferred)
Minimum of 2 years of experience in medical billing and coding
Minimum of 2 years of experience in correspondence and medical claim denials
Strong understanding of medical billing regulations and procedures, including ICD-10, CPT coding, and healthcare insurance guidelines
Excellent communication skills, both verbal and written
Strong attention to detail and ability to work in a fast-paced environment
Proficiency in medical billing software and general office software (e.g., Microsoft Office)
What's in it for You?
Medical, Dental, and Vision Insurance401(k) with 4% Matching
Paid Time Off (PTO)
Numbers & Facts
Location
Irvine, CA
Skills
Billingunmatched
Billing Softwareunmatched
Claims Managementunmatched
Communication Skillsunmatched
Current Procedural Terminology (CPT)unmatched
Detail Orientedunmatched
Health Insuranceunmatched
Healthcareunmatched
Healthcare Administrationunmatched
Healthcare Softwareunmatched
High School Diplomaunmatched
ICD-10unmatched
Insuranceunmatched
Medical Billingunmatched
Medical Codingunmatched
Medical Recordsunmatched
Medical Treatmentunmatched
Microsoft Officeunmatched
Patient Care Denialsunmatched
Presentation/Verbal Skillsunmatched
Regulationsunmatched
Regulatory Complianceunmatched
Reimbursementunmatched
Time Managementunmatched
Writing Skillsunmatched
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