Medical Claims Specialist

1 week ago


Costa Mesa, California, United States Hoag Memorial - Red Hill Clinic Full time

Job Summary:

We are seeking a skilled Medical Claims Specialist to join our team at Hoag Memorial - Red Hill Clinic. As a Medical Claims Specialist, you will be responsible for ensuring the accuracy and compliance of medical claims, working with multiple parties to resolve issues, and maintaining up-to-date records.

Key Responsibilities:

  • Respond to inquiries related to claims, eligibility, and authorization
  • Ensure accuracy and compliance with regulatory guidelines and health plan requirements
  • Document actions taken following HIPAA guidelines
  • May assist in providing customer service and working with providers/billing offices
  • May maintain databases, audit information, and work with patients to process patient payments
  • May follow up with insurance companies on outstanding or unpaid claims and create/send statements to patients

Requirements:

  • High School Diploma or equivalent
  • At least 2 years of medical billing experience, preferably in a hospital setting
  • 1+ years of experience in medical claims
  • Experience in and knowledge of all medical billing protocols, including HCPCS, ICD-10, and CPT codes, as well as EMR system experience

Benefits:

Pride Global offers eligible employees comprehensive healthcare coverage, supplemental coverage, 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Equal Opportunity Employer:

Pride Global and its affiliates are committed to creating a diverse environment and are proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.



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