Claims Review Specialist

99% remote, only the orientation will be onsite and a few meetings when necessary.
CPC-H, CPC, or CCS coding certification required.
Please submit qualified candidates. REQUIRED EXP: 5 yrs exp with hospital billing systems and third-party billing requirements, Bachelor’s Degree, Epic, coding certification (CPC,CPCH, AHIMA etc) Preferred: Knowledge of ICD10CM CPT, Medicare, Medi-Cal and Commercial Payers processing, Denials management

Job Summary:
We are seeking a detail-oriented Claims Specialist to join our team. The ideal candidate will have a strong background in medical terminology, coding, and Medicare processes. As a Claims Specialist, you will be responsible for processing and managing insurance claims efficiently and accurately.

Responsibilities:
- Review and process medical claims for accuracy and completeness
- Verify insurance coverage and eligibility for claim submission
- Ensure compliance with Medicare, HCPCS, ICD-10, and other coding standards
- Analyze medical documentation to determine claim validity
- Communicate with healthcare providers and insurance companies to resolve claim issues
- Maintain accurate records of claims processed and payments received
- Stay updated on changes in workers' compensation laws and regulations

Qualifications:
- Proficiency in medical coding and terminology
- Experience with Medicare billing procedures
- Knowledge of HCPCS, ICD-10, and medical records management
- Strong clerical and organizational skills
- Familiarity with workers' compensation law is a plus

This position offers the opportunity to work in a dynamic healthcare environment, where attention to detail and accuracy are essential. If you have a passion for ensuring accurate claims processing and enjoy working with medical documentation, we encourage you to apply for the Claims Specialist position.

Job Types: Full-time, Contract

Pay: $25.00 - $30.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Hybrid work

Education:

• Bachelor's (Required)

Experience:

• Hospital Billing Systems: 5 years (Required)
• Third-party billing requirements: 5 years (Required)
• Epic: 1 year (Required)
• CPT coding: 5 years (Preferred)
• ICD-10: 5 years (Preferred)
• Medicare, Medi-Cal and Commercial Payers processing: 1 year (Preferred)
• Denials management: 1 year (Preferred)

License/Certification:

• Certified Coding Professional (Preferred)
• Certified Coding Specialist (Preferred)
• CPCH (Preferred)
• AHIMA (Preferred)

Ability to Relocate:

• Los Angeles, CA 90024: Relocate before starting work (Required)

Work Location: Hybrid remote in Los Angeles, CA 90024