Premier Health Group
Medical Claims Specialist
Premier Health Group, Newport Beach, California, us, 92659
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).
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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).
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