Medical Claims Specialist

4 weeks ago


Costa Mesa, California, United States Hoag Memorial Hospital Presbyterian Full time

Job Summary:

The Medical Claims Specialist will serve as the account representative for Hoag Memorial Hospital Presbyterian, working with insurance companies, government payors, and/or patients to resolve payments and accounts. This role requires strong analytical and communication skills to ensure timely and accurate reimbursement.

Key Responsibilities:

  • Evaluate claims at the contract rate using the contract management tool for proper pricing
  • Review and initiate initial appeals for underpayments, observing all timely requirements
  • Complete payor and/or patient correspondence in a timely manner
  • Escalate accounts that need to be appealed due to improper billing, coding, and/or underpayments
  • Report new/unknown billing edits to direct supervisor for review and resolution

Requirements:

  • High school diploma or equivalent required
  • Three years of experience in a hospital/medical and/or related field or strong background in customer service
  • Working knowledge of Epic Resolute, Eric Care, and Epic CPOE
  • Intermediate Excel knowledge is a must

About Hoag:

Hoag Memorial Hospital Presbyterian is a nonprofit, regional healthcare delivery system in Orange County, California. We deliver world-class, comprehensive, personalized care, with a team of 1,800 top physicians, 15 urgent care facilities, 10 health and wellness centers, and two award-winning hospitals.

We offer a comprehensive blend of health care services, including seven institutes providing specialized services in cancer, digestive health, heart and vascular, neurosciences, spine, women's health, and orthopedics through our affiliate, Hoag Orthopedic Institute.

Hoag is the highest-ranked hospital in Orange County by U.S. News & World Report and the only OC hospital ranked in the Top 10 in California, as well as a designated Magnet hospital by the American Nurses Credentialing Center (ANCC).



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