Medical Claims and Billing Specialist

2 days ago


Ladera Ranch, California, United States American Family Care Ladera Ranch Full time

Join American Family Care Ladera Ranch as a Medical Claims and Billing Specialist, where you will play a crucial role in ensuring the smooth operation of our medical billing process. In this position, you will be responsible for organizing and prioritizing all incoming claims and denials, evaluating medical claims and coverage policy documentation to determine validity for an appeal, and working with leadership to develop appropriate policies and procedures.

Company Overview

American Family Care (AFC) is one of the largest primary and urgent care companies in the U.S., providing services seven days a week on a walk-in basis. Our state-of-the-art centers focus on the episodic treatment of acute illnesses and injuries, workers' compensation, and occupational medicine. Each location is equipped with an onsite lab and in-house x-ray capability. As a Medical Claims and Billing Specialist at AFC Ladera Ranch, you will work directly with a franchised business location, utilizing your knowledge of Local and National Coverage Determinations and payor policies to resolve complex client problems.

Salary and Benefits

The estimated salary for this position is $65,000 - $75,000 per year, depending on experience. As a valued member of our team, you can expect a comprehensive benefits package, including paid vacation, health insurance, dental insurance, retirement benefit, and more. You will also have opportunities for professional growth and development within our organization.

Job Description

Your primary responsibilities as a Medical Claims and Billing Specialist will include:

  • Organizing and prioritizing all incoming claims and denials;
  • Evaluating medical claims and coverage policy documentation to determine validity for an appeal;
  • Responsible for ensuring and monitoring the effectuation of all decisions as a result of the follow-up of unpaid/denied claims with insurance carriers;
  • Responsible for adhering to health care billing procedures, documentation, regulations, payment cycles, and standards;
  • Work accounts to resolution;
  • Collection from patients and insurances;
  • Works collaboratively and effectively with all other departments and functions to maximize operational efficiency and service and ensure consistency in addressing appeals issues;
  • Work independently to identify and resolve complex client problems;
  • Work with leadership to develop appropriate policies and procedures;
  • Maintain current knowledge of healthcare billing laws, rules and regulations, and developments;
  • Comply with all applicable HIPAA policies and procedures and maintain confidentiality.

You will have the opportunity to work with a variety of different payors and manage multiple projects simultaneously, making this a challenging and rewarding role for those who enjoy problem-solving and working in a fast-paced environment.



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