- Reviewing data and creating Claims for services rendered
- Review client records to extract applicable data necessary for billing purposes, including but limited to ICD 10 Diagnosis codes, CPT codes for services rendered etc.
- Review any rejected or denied claims and conduct proper follow up procedures.
- Ensure claims meet the standards of our contracts and programs.
- Verify eligibility of each client prior to creating and submitting claims.
- Have knowledge in understanding, reading EOB's and Remittance Advice
- Posting payment accurately to claims and continuing with the claim close out process.
- Assist Manager and Associate Director in any projects related to billing that may come up.
- Reviewing encounters for PCP, Psychiatry, and behavioral health, ensuring CPT codes, and ICD 10 codes used by Dr are applicable to the service rendered before submitting encounter as a claim.
- Familiar with Athena or similar EHR system
- Verifying client's insurance falls into one our contracted insurance prior to billing
- Following up on claims that were denied, rejected, or held in the EHR system which includes appeals, corrections, resubmissions
- High School Diploma or equivalent.
- 1-2 years' relevant experience.
- Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets.
- Valid CA Driver's License and eligibility for company vehicle insurance.
- Prior experience work in Electronic Billing Platforms and EHR systems
- Prior experience working with claims and communication with health networks
- Proficiency in Microsoft (Outlook, Word, Excel, Teams).
- Associate's Degree
- Bachelor's degree
- Experience in Medical Billing and Primary Care Billing
- Medical Billing Certification
- Hybrid schedule with 2 days in office and 3 days working from home (After successful completion of 90-day probation period)
- Medical Insurance funded up to 91% by Illumination Foundation (Kaiser and Blue Shield), depending on the plan
- Dental and Vision Insurance
- Life, AD&D and LTD Insurance funded 100% by Illumination Foundation
- Employee Assistance Program
- Professional Development Reimbursement
- 401K with Company Matching
- 10 days vacation PTO/year
- 6 days sick PTO/year
- 10 days holiday PTO/year
- Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans
-
Claims Specialist
2 weeks ago
Illumination Foundation Santa Ana, United States"Every person deserves compassion, dignity, and the safety of a place to call home." · Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessn ...
-
Claims Specialist
23 hours ago
9992 Orange, United StatesJob Description · Job DescriptionThe Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, ...
-
Claims Specialist
1 week ago
Illumination Foundation Santa Ana, United States"Every person deserves compassion, dignity, and the safety of a place to call home." · Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessne ...
-
Claims Resolution Specialist
23 hours ago
Ultimate Staffing Services Orange, United StatesJob Description · Job DescriptionClaims Resolution Specialist (Customer Service) · Orange, CA (On-Site) · Schedule: 8am-5pm · Salary: - $24/Hour · The Claims Resolution Specialist will be the first line of contact for Health providers. The incumbent will assist providers with qu ...
-
Claims Resolution Specialist
5 days ago
Cross Country Workforce Solutions Group Orange, United StatesJob Description · Job DescriptionJob Summary · The Claims Resolution Specialist is the first line of contact for providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. · Position Responsibilities · C ...
-
Claims Resolution Specialist
18 hours ago
Cross Country Workforce Solutions Group Orange, United StatesJob Description · Job Description · Job Summary · The Claims Resolution Specialist is the first line of contact for providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. · Position Responsibilit ...
-
claims specialist
1 week ago
Hoag Health Network Costa Mesa, United StatesSalary Range: $ $ /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education. The Claims Specialist (Customer Service) is responsible for answering phone calls from healthcare provide Claims, Claims Specialist, Specialist, Custom ...
-
Group Claims Specialist
2 weeks ago
Lincoln Financial Group Irvine, United StatesWhat you'll be doing · Communicating with claimants, employers and various medical professionals through phone and e-mail to gather necessary claim information, managing the claim process from the initial request to the return to work. · Collaborating with fellow case managers, ...
-
Claims Specialist
2 weeks ago
CorVel Corporation Rancho Cucamonga, United States Full timeThe Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of ...
-
Claims Resolution Specialist
2 weeks ago
The Judge Group Inc. Orange, United StatesLocation: Orange, CA · Salary: $24.00 USD Hourly - $33.00 USD Hourly · Description: · Judge Healthcare is currently seeking Claims Resolution Specialist in Orange, CA · Contract: 6+ months · Hours: Monday-Friday, business hours · Location: On-site (Orange, CA) · The Claims ...
-
Claims Resolution Specialist
1 week ago
Cogent Infotech Corporation Orange, United StatesJob Description · Job DescriptionDescription : · The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client's providers. The inc ...
-
Claims Recovery Specialist
2 weeks ago
CalOptima Orange, United States**Claims Recovery Specialist** · **CalOptima** · **CalOptima Health** is seeking a highly motivated an experienced **Claims Recovery Specialist** to join our team. The Claims Recovery Specialist will be responsible for performing recoveries on claims that have been overpaid and m ...
-
Claims Specialist
2 weeks ago
CorVel Enterprise Comp, Inc. Rancho Cucamonga, United StatesJob Description · Job DescriptionThe Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims prof ...
-
Claims Resolution Specialist
5 days ago
Infoway Solutions LLC Orange, United States**Duties & Responsibilities**: · **80% - Claims Support** · - Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial r ...
-
claims specialist
5 days ago
Hoag Memorial Hospital Presbyterian Costa Mesa, United StatesSalary Range: $ $ /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education. · The Claims Specialist (Customer Service) is responsible for answering phone calls from healthcare providers, health plans, billing companies, and me ...
-
Cogent Infotech Corp Orange, United States: · The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client's providers. The incumbent will assist providers with questions ...
-
Now Hiring Specialist, Claims
2 weeks ago
Alex Mora - State Farm Agency Orange, CA, United States Full timeBilingual Life and Health Specialist - Spanish · Alejandro Mora - State Farm Agency, located in Orange, CA has an immediate opening for a full-time Bilingual (Spanish/English) Licensed Insurance Life and Health Specialist. Must have an active Life and Health insurance license. F ...
-
Claims Specialist
1 week ago
Hoag Memorial Hospital Presbyterian Costa Mesa, United States**Salary Range**: $ $ /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education. · - The Claims Specialist (Customer Service) is responsible for answering phone calls from healthcare providers, health plans, billing companies, a ...
-
ESIS Claims Specialist, WC
2 weeks ago
Chubb Irvine, United StatesJob Description · The ESIS Senior Work Comp Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. · Note: This is a hybrid position requiring 3 days in the Chats ...
-
Senior Claims Specialist
1 week ago
Providence Health & Service Anaheim, United StatesThe Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have k Claims Specialist, Claims, Sp ...
Claims Specialist - Santa Ana, United States - Illumination Foundation
Description
Job Description
Job Description"Every person deserves compassion, dignity, and the safety of a place to call home."
Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care centers, emergency shelters, housing services and children's and family programs. IF currently has 13+ facilities with 22+ micro-communities scattered across Orange County, Los Angeles County and the Inland Empire.
Job Description
The Claims Specialist is responsible for accuracy of claims submission, benefits and eligibility verification, accuracy of client information. In addition, the Claims Specialist is also responsible for keeping up to date accounts receivable for both CalAIM and IFMG, claim follow-up, and must have knowledge of billing codes.
The pay range for this position is $ $27.00 per hour, depending on experience. This position can be based out of Santa Ana or Riverside. After successful completion of 90-day probation period, this position will be eligible for Hybrid schedule with 2 days in office and 3 days working from home.
Responsibilities
CalAIM Billing and Follow upPreferred Experience/Minimum Qualifications
Required:
Preferred:
Benefits
Powered by JazzHR
hAOHSIOPSI