Claims Specialist

2 days ago


Riverside, California, United States Illumination Foundation Full time
Job Description:

The Claims Specialist is responsible for ensuring the accuracy of claims submission, benefits, and eligibility verification, as well as maintaining up-to-date accounts receivable for both CalAIM and IFMG. This role requires knowledge of billing codes and the ability to review client records to extract applicable data necessary for billing purposes.

Responsibilities:

Reviewing data and creating claims for services rendered
Reviewing client records to extract applicable data necessary for billing purposes, including ICD 10 Diagnosis codes, CPT codes for services rendered, etc.
Reviewing rejected or denied claims and conducting proper follow-up procedures
Ensuring claims meet the standards of our contracts and programs
Verifying eligibility of each client prior to creating and submitting claims
Posting payment accurately to claims and continuing with the claim close-out process

Preferred Experience/Minimum Qualifications:

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 working with claims and communication with health networks

Benefits:

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
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