Medical Billing Specialist

3 weeks ago


Los Angeles, California, United States MedPOINT Management Full time
Job Description

We are seeking an experienced Medical Billing Specialist to join our team at MedPOINT Management. As a key member of our Finance Auditing & Recoveries unit, you will play a crucial role in ensuring the accuracy and integrity of our claims submissions.

In this exciting opportunity, you will collaborate with our Manager, Lead, claims staff, and Health Plans to submit, monitor, and track the FFS Billing process. Your responsibilities will include:

  • Running reports for FFS claims monthly;
  • Cross-training on other tasks and reporting requirements within the unit;
  • Making sure claims are submitted to the Health Plan electronically monthly by EDI Unit;
  • Working any rejections of the claims submitted electronically to Health Plan;
  • Printing onto CMS 1500 or UB04 forms to bill Health Plan when needed;
  • Reviewing payments for correct payment amount & Co-Pay;
  • Reviewing denials for services denied by Health Plan in error;
  • Reviewing denials for issues with the way the provider bills the claim to IPA/Client;
  • Appealing any underpayments or inappropriate denials / denials made in error by Health Plan;
  • Responding to requests for additional information;
  • Appealing payment denials and/or under payments identified to be in error;
  • Researching and resolving Health Plan requests for refunds;
  • Researching and resolving submissions without a response from Health Plan;
  • Reporting monthly of submitted, paid, denied services as well as issues with payments and provider billing.


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