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Healthcare Claims Specialist
2 months ago
About the Position
As a vital member of our team, you will play a key role in ensuring the precise and prompt processing of healthcare claims.
Position Details
Compensation: $45.72 / hour
Location: Ontario, California
Profession:
Claims Processing
Facility Type:
Healthcare
Specialty:
Health Insurance
Division:
MedFi
Key Responsibilities
Assess the eligibility of patients for coverage and verify if the services or treatments provided are included under their insurance policy.
Engage with healthcare providers, insurance agents, and policyholders to gather further information, clarify specifics, or resolve any inconsistencies related to submitted claims.
Investigate claims appeals and grievances utilizing support systems to ascertain the outcomes of appeals and grievances.
Maintain comprehensive records of all claims processed, encompassing denials, payments, adjustments, and any communication pertinent to the claims.
Calculate the payment or reimbursement amount for each claim based on the patient's benefits, provider agreements, fee schedules, and other relevant criteria.
Essential Qualifications
Familiarity with Medicaid and Medicare claims denial and appeal processes
Minimum of 2 years of experience in claims processing
Proficient computer skills
