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Medical Claims Specialist

Company: Healthcare Support
Location: Long Beach
Posted on: January 13, 2022

Job Description:

Are you an experienced Medical Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the Medical Claims Specialist position for you!

Daily Responsibilities of a Medical Claims Specialist:
Resolves and prepares written response to incoming member or provider appeals, grievances, complaints and/or disputes.
--- Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
--- Identifies potential provider problems through a proactive approach in which data is mined and trended to identify and prevent provider problem areas.
--- Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed.
--- Requests and reviews medical records, notes, and/or detailed bills as appropriate and collaborates with Medical Directors and other team members to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines.

High School diploma or GED equivalent
2-3 years experience in a managed care setting; CPT and ICD-9 coding, data entry, and 10-Key experience.
2-3 years managed care experience; claims review and processing background including coordination of benefits, subrogation, and eligibility criteria

Hours for this Position:
Monday to Friday 8AM - 4:30 PM with 30-minute lunch or 7AM - 4PM with 30-minute lunch (contractors will not be required to work on Federal holidays) - allowed to work in their times zone

Advantages of this Medical Claims Specialist Opportunity:
Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment

Interested in being Considered?
If you are interested in applying to this Medical Claims Specialist position, please click Apply Now for immediate consideration.

Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Keywords: Healthcare Support, Long Beach , Medical Claims Specialist, Healthcare , Long Beach, California

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