Claims Specialist

2 weeks ago

Signal Hill, United States Aspiranet.org Full time

Do you have experience in Medi-Cal billing within Los Angeles County Department of Mental Health (LACDMH)? Are you excited to work independently or as part of a team? Do you feel at home in a supporting role providing assistance to Managers and Social Service staff?

The **Claims Specialist for th**e **Los Angeles County Department of Mental Health** **Wraparound program in Signal Hill**, California, is part of a strengths-based, highly skilled and passionate team working together to ensure the safety of youth by providing services centered on improving behavior and maintaining placement in their home.

**Your Skills and Duties**
- Submit timely weekly billing to LACDMH using Electronic Health Record System (EHRS), EXYM. Manage, track and resolve denied and voided claims, following through until claim is paid.
- Reviewing the completeness, accuracy, and timely input of all required data entered into LA County and Agency databases (i.e., NAPPA, NPPES, ProviderConnect).
- Coordinate monthly chart audits with Program Manager/HOS; reviewing charts for compliance, accountability and internal responsibility.
- Generate and distribute accurate and timely reports on a daily, weekly, monthly and quarterly basis, and preparing reports in response to audits including plans of correction
- Monitors programs and services in order to ensure desired changes are effective objectives which are achieved, and program changes are maintained.
- Attend and participate in monthly Peer Review/Compliance meetings per County and Agency guidelines, including LACDMH Network Adequacy and QA/QI Meetings, as assigned.
- Accountable for current knowledge of utilization management responsibilities, including regulations and payer information (i.e. EPSDT, insurance standards).
- Assist Program Manager/HOS to provide oversight and administrative assistance in tracking documents, monitoring best practices regarding documentation and billing, and maintaining client privacy and dignity.
- Reviews Satisfaction Survey and other outcome data and disseminates results and staff/client comments to Program Manager/HOS; assist in the development of systems identified as opportunities for improvement and the collection of this data.
- Demonstrate sensitivity and responsiveness to cultural differences.
- Maintain appropriate professional boundary areas with staff, clients, families and community resources.
- Support and model Aspiranet's values, represent the Agency in a professional manner, and abide by the Agency's Professional Code of Ethics.
- Follow all HIPAA compliance guidelines to ensure the confidentiality of all client information at all times.
- Perform other duties as deemed necessary for the fulfillment of program requirements.

**Education and Work Experience**:

- High School Diploma/GED; plus two years’ relevant work experience.
- Preferred experience with LACDMH policies and procedures.
- Preferred experience with Medi-Cal eligibility and billing and billing within the LACDMH Contract(s).
- Experience working in EHRS, EXYM highly preferred.
- Proficient in Microsoft Office Suite; Outlook, Word, Excel
- Strong written and oral communication skills; ability to analyze and interpret data, and to effectively communicate.
- Flexibility to manage the assigned workload in order to meet task deadlines.
- Ability to prioritize multiple tasks; detail-oriented, attentive, organized and able to follow directions.
- Experience and knowledge operating and maintaining standard office equipment such as a copier, and printer.
- Meets all state required conditions of employment as set forth by Community Care Licensing for a Licensed Community Care facility; i.e. Fingerprint and Child Abuse.
- Index clearance, TB/Health Physical, valid CDL and clean driving record.
- Meets all compliance requirements of federal, state, and county regulations by periodic sanction checks.

**Compensation**: Competitive DOE

**Benefits**:
**Flexible Time Off**
- 13 paid holidays along with 10 vacation and 10 sick days

**Comprehensive Healthcare**
- Medical, dental and vision plans
- A 100% fully employer paid (premium) medical and dental benefit plan
- TelaDoc® employer paid telehealth program

**Flexible Spending Accounts**
- Medical and dependent care plans

**Retirement Savings**
- 403(b) and 401(a) retirement plan with employer contributions

**Income Protection**
- Life, AD&D, and disability insurance
- Accident, critical illness, and hospital gap plan

**Training and Advancement**
- Ongoing training & development opportunities
- Advancement opportunities

**Employee assistance program**
- Free confidential crisis line 24/7 (365 days a year)
- Six (6) face-to-face or telephonic sessions per issue

**Other Perks**
- Commuter program and mileage reimbursement
- Employee recognition and discount programs

**EEO/AA**

Aspiranet is proud to be an equal employment opportunity employer; all applicants will be given full consideration under state, local, and federal law.

**

  • Claims Resolution Specialist

    3 weeks ago

    Camp Hill, United States Select Medical Full time

    Overview: Claims Resolution Specialist Starting at $17.50 per hour On-Site (Hybrid Schedule Possible After 90 Day Probationary Period) Do you enjoy puzzles and research? Are you results-oriented? If so, our Claims Resolution Specialist position may be a phenomenal career for you within Select Medical! Our dynamic team has the responsibility of resolving...

  • Claims Resolution Specialist

    4 weeks ago

    Camp Hill, United States Select Medical Full time

    Overview: Claims Resolution Specialist Starting at $17.50 per hour On-Site (Hybrid Schedule Possible After 90 Day Probationary Period) Do you enjoy puzzles and research? Are you results-oriented? If so, our Claims Resolution Specialist position may be a phenomenal career for you within Select Medical! Our dynamic team has the responsibility of resolving...

  • Claims Resolution Specialist

    3 weeks ago

    Camp Hill, United States Select Medical Full time

    Overview: Claims Resolution Specialist Starting at $17.50 per hour ON-SITE (Hybrid Schedule Possible After 90 Day Probationary Period) Do you enjoy puzzles and research? Are you results-oriented? If so, our Claims Resolution Specialist position may be a phenomenal career for you within Select Medical! Our dynamic team has the responsibility of resolving...

  • Claims Specialist II, General Liability, Dedicated Team

    2 weeks ago

    Rocky Hill, United States Zurich Insurance Group Full time

    Zurich North America is seeking a skilled Claims Specialist to handle Commercial General Liability (CGL) litigated files within our dedicated team for one of our largest customers! This exciting opportunity is available in one of the following locati Claims Specialist, General Liability, Claims, Liability, Specialist, Total Rewards

  • Claims Specialist I, General Liability

    3 weeks ago

    Rocky Hill, United States Zurich Insurance Company Full time

    At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating...

  • Billing Specialist Wraparound

    4 days ago

    Signal Hill, United States Aspiranet.org Full time

    **Location**: Signal Hill, CA, USA **Requisition Number**13509** **Department**:Intensive Home-Based Services** Do you have experience in Medi-Cal billing within Los Angeles County Department of Mental Health (LACDMH)? Are you excited to work independently or as part of a team? Do you feel at home in a supporting role providing assistance to Managers and...

  • Claims Specialist Ii, General Liability, Dedicated

    3 weeks ago

    Rocky Hill, United States Zurich Insurance Company Ltd. Full time

    **pspan style=font-size**: 12.0pxspan style=font-family: Arial, Helvetica, sans-serifZurich North America is seeking a skilled Claims Specialist to handle Commercial General Liability (CGL) litigated files within our dedicated team for one of our largest customers! This exciting opportunity is available in one of the following locations: Rocky Hill, CT,...

  • Integrated Absence Specialist- in Office or Remote

    4 days ago

    Signal Hill, United States TRISTAR RISK MANAGEMENT Full time

    **This position can be in Office at our Signal Hill branch or Remote. Working remote will depend whether TRISTAR does not have an office in your area.** **3-5 years of FMLA experience required** ***:Sets up and administers Leave of Absence, Voluntary Disability, Paid Family Leave, Short Term Disability and Long Term Disability Claims in accordance with...

  • Integrated Absence Specialist- in Office or Remote

    4 days ago

    Signal Hill, United States TRISTAR RISK MANAGEMENT Full time

    **In Office or Remote (In Area).** **3-5 years of FMLA experience required** ***:Sets up and administers Leave of Absence, Voluntary Disability, Paid Family Leave, Short Term Disability and Long Term Disability Claims in accordance with TRISTAR ICS protocols and Employer specific service requirements. **ESSENTIAL DUTIES AND RESPONSIBILITIES**: This...

  • Claims Specialist II, General Liability, Dedicated Team

    5 days ago

    Rocky Hill, Connecticut, United States Zurich Insurance Group Full time

    Zurich North America is seeking a skilled Claims Specialist to handle Commercial General Liability (CGL) litigated files within our dedicated team for one of our largest customers This exciting opportunity is available in one of the following locations: Rocky Hill, CT, Schaumburg, IL, Parsippany, NJ, New York, (WTC). With moderate direction, this position...

  • Provider Relations Coordinator

    4 weeks ago

    Signal Hill, United States Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

  • Insurance Specialist Insurance Specialist

    3 weeks ago

    Chapel Hill, United States Capleo Global Full time

    Job Title: Insurance Specialist Location: 140 Dental Cir Chapel Hill, NC 27514 Duration: 11 Months Shift: M-F 8:30 - 5, or 4 days/week for 10 hour days Job Description: This Insurance Specialist position performs both dental and medical insurance services for the Client. The Insurance Specialist position works in all areas of billing and reimbursement...

  • Insurance Specialist

    2 months ago

    Chapel Hill, United States Capleo Global Full time

    Job Title: Insurance Specialist Location: 140 Dental Cir Chapel Hill, NC 27514 Duration: 11 Months Shift: M-F 8:30 - 5, or 4 days/week for 10 hour daysJob Description: This Insurance Specialist position performs both dental and medical insurance services for the client. The Insurance Specialist position works in all areas of billing and reimbursement from...

  • Insurance Specialist

    1 month ago

    Chapel Hill, United States Eclaro Full time

    Position Overview: This Insurance Specialist position performs both dental and medical insurance services for the Client School of Dentistry. The Insurance Specialist position works in all areas of billing and reimbursement from private dental insurance companies as well as Managed Care companies. This position requires specialized knowledge of...

  • Insurance Specialist

    1 month ago

    Chapel Hill, United States Experis Full time

    Job Description: Insurance Specialist Pay Rate: $18 - $20 per hour Location: Chapel Hill, NC Summary: We are searching for a skilled Insurance Specialist to manage both dental and medical insurance processes. This position is crucial for ensuring accurate billing and reimbursement for our dental services. Responsibilities: Process dental insurance claims...

  • Insurance Specialist

    3 weeks ago

    Chapel Hill, United States Experis Full time

    Job Description: Insurance Specialist Pay Rate: $18 - $20 per hour Location: Chapel Hill, NC Summary: We are searching for a skilled Insurance Specialist to manage both dental and medical insurance processes. This position is crucial for ensuring accurate billing and reimbursement for our dental services. Responsibilities: Process dental insurance claims...

  • Insurance Specialist

    5 days ago

    Chapel Hill, Tennessee, United States Hays Recruitment Full time

    Hays Investor Work for Hays About Us Find Us US EN For Job Seekers For Organizations Australia Austria Belgium Brazil Canada Chile China Colombia Czech Republic Denmark France Germany Hong Kong SAR Hungary Italy Japan Luxembourg Malaysia Mexico Netherlands New Zealand Poland Portugal Romania Singapore Spain Sweden Switzerland Thailand UAE United Kingdom...

  • Property Claims Specialist Field II Ideal Candidate in San Jose

    1 week ago

    Morgan Hill, United States Mercury Insurance Full time

    Position Summary: If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field...

  • Medical Billing Specialist

    1 month ago

    Oxon Hill, United States Moore OBGYN Full time

    Job DescriptionJob DescriptionJob Title: Medical Billing SpecialistBilingual Spanish, a plusPosition Summary: The Medical Billing Specialist utilizes knowledge of insurance regulations, health insurance contracts, medical coding, and bookkeeping to perform a variety of revenue cycle support activities. These include but are not limited to medical coding,...

  • Medical Billing Specialist

    3 weeks ago

    Oxon Hill, United States Moore OBGYN Full time

    Job DescriptionJob DescriptionJob Title: Medical Billing SpecialistBilingual Spanish, a plusPosition Summary: The Medical Billing Specialist utilizes knowledge of insurance regulations, health insurance contracts, medical coding, and bookkeeping to perform a variety of revenue cycle support activities. These include but are not limited to medical coding,...