HealthCare Claims Clerk (On-site)

Job Description

Job Description

Since 1957, Shield Healthcare has provided high-quality healthcare services while focusing on customer satisfaction and employee achievement. We are dedicated to fulfilling the medical supply needs of consumers and the caregiving community while maintaining a 99% overall customer satisfaction rating. Over the years, Shield HealthCare has expanded nationally with current service locations in California, Colorado, Illinois, Ohio, Texas and Washington.

Shield HealthCare is looking for a Healthcare Claims Clerk to research medical supply claims rejections, denials, and underpayments, making the necessary corrections to meet billing guidelines or recommending claims for write-off. The position has a set schedule, Monday through Friday, no nights or weekends. 

This is an on-site position in Valencia, CA.

JOB RESPONSIBILITIES:

• Reviews the claims billing processes, looking for ways to achieve positive financial outcomes
• Identify problems and find solutions to claim rejections, denials, and underpayments
• Inform management of trends in billing issues related to internal processes, clearinghouse claims processing, and third-party requirements
• Research denials and billing requirements of third-party carriers utilizing EOBs, provider manuals, web portals, and phone contact
• Adjudicate claims issues by preparing and submitting corrected claims and appeals
• Recommend claims for write-off when billing requirements are not met
• Effectively communicate by phone, email, and in-person with third-party payers and internal staff to resolve billing issues and establish positive relationships
• Accurately update and notate accounts receivable system, collections notepad, and customer accounts
• Remain updated on company policies and procedures and third-party payer guidelines, bulletins, and billing requirements
• Ensure appropriate follow-up and timely completion of assignments
• Completes special projects as assigned, supporting team and organizational objectives and continuous improvement initiatives

QUALIFICATIONS:

• High school diploma or equivalent
• 2 years in a medical billing or collections role or similar experience
• Medical billing and coding certification from accredited program preferred
• Familiarity with various medical insurance payer guidelines/billing requirements preferred
• Proficiency in Microsoft 365 (Excel, PowerPoint, Word, SharePoint, Teams)
• Experience working in Excel
• Strong written and verbal communication abilities
• Proven ability to research and solve problems
• Strong organizational skills, detail oriented, thorough, accurate, with the ability to manage multiple priorities and respond to changing business needs

PAY & BENEFITS:

• $19.50/hour
• Medical, Dental, and Vision (Available first day of employment)
• 401(k) with Company Match 
• Sick and Vacation Days 
• Flexible Spending Account 
• Life & Disability Insurance 
• Education Assistance

Career-minded individuals will find our business challenging and our reputation for excellence just one of the rewards we have to offer. To further enhance this tradition of excellence, our employees participate in continuous training and development programs in a variety of disciplines.

The posted range for this position is $19.50/hour which is the expected starting base salary range for an employee who is new to the role to fully proficient in the role. Many factors go into determining employee pay withing the posted range including education, prior experience, training, current skills, certifications, location/labor market, internal equity, etc.

Shield Healthcare, Inc. is an Equal Employment Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, creed, national origin, ancestry, disability that can be reasonably accommodated without undue hardship, sex, sexual orientation, gender identity, age, citizenship, marital or veteran status, or any other legally protected status.