medical claims processor

Blue Shield of California

<div>Your Role 
The Medi-Cal Operations team is responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Medi-Cal Operations Supervisor. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases. 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work 
In this role, you will:
<ul><li>Handle most complex activities including backup for all areas of claims processing
</li><li>Actively participate in projects
</li><li>Handle escalated issues independently
</li><li>Mentor experienced team members
</li><li>Assist with training when needed
</li><li>Collaborate with peers, staff in other department's vendors, and Management to improve processes and department work quality.
</li><li>Must be able to work in a fast-paced environment with minimal supervision
</li><li>Read and interpret documents such as provider contracts procedure manuals, various reports, division of financial responsibility matrix</li></ul></div>
 <div>Your Knowledge and Experience 
<ul><li>Requires a high school diploma or GED
</li><li>Requires at least 7 years of experience
</li><li>Minimum of 3 years of experience in claims processing and/or auditing experience in a manage care setting required
</li><li>Experience examining multiple claim types in the Medi-Cal/Medicare environment preferred
</li><li>Knowledge of medical claims regulatory guidelines such as AB1455 and Medicare preferred
</li><li>Proficiency in Microsoft Office programs such as Excel, Word and Outlook required 
</li></ul>Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

Claims Processor, Specialist

Medlogix

<div><div><div>Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix&reg; technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients&rsquo; needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers&rsquo; compensation insurance carriers; third party administrators (TPAs); and government entities we serve.<div> 
Position: Bill Repricer Level II</div><div>
Location: Remote</div><div>
FMLA: Non-Exempt, Full-Time</div><div>
Schedule: M-F 8am-4:30pm</div><div> 
Job duties:</div><div></div><div> 
<ul><li>
Process and reprice auto medical claims through different system queues in &ldquo;first in first out&rdquo; order and making sure to keep up with client and regulatory SLAs</li><li>
Maintain communication when needed, between yourself and your supervisor</li><li>
Reach a daily average quota with the amount of claims/jobs you process</li><li>
Manually key medical bills from a HCFA, UB, NF-3 or Non-standard billing form</li><li>
Correct, verify and insert new provider information from bills that are in the processing phase</li><li>
Associate and claim match medical bills and additional documents from providers to their correct claim files located in MyMedlogix. These documents may come in large packets/files from providers that could contain multiple patients and documents and will need to be split up manually</li><li>
Other job duties as assigned</li></ul></div><div></div><div> 
Qualification:</div><div></div> 
Required:<ul><li>
Excellent written and verbal communication skills</li><li>
Must be process and task oriented</li><li>
Computer savvy and previous experience using Microsoft Office Products</li></ul><div></div> 
Preferred:
1+ years medical coding experience - CPT, ICD<div></div> 
EEOC STATEMENT:
Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.</div></div></div>

Bill Repricer - Level I (Remote)

B-Line Counseling LLC

Job Summary We are seeking a dynamic and bilingual Medical Biller/Receptionist to join our team! In this vital role, you will serve as the first point of contact for patients and providers, ensuring smooth front-office operations while managing accurate medical billing processes. Your bilingual skills will help bridge communication gaps, providing exceptional service to diverse patient populations. This position offers an exciting opportunity to utilize your medical billing expertise, attention to detail, and friendly demeanor to contribute to a positive healthcare experience.Responsibilities<ul><li>Collect patient information, verify insurance details, and update medical records accurately within Electronic Health Record (EHR) systems.</li><li>Prepare and submit medical claims using CPT (Current Procedural Terminology), ICD-9, ICD-10 coding systems, ensuring compliance with billing standards.</li><li>Maintain detailed and organized medical records while adhering to privacy regulations and documentation standards.</li><li>Process and submit medical claims accurately and in a timely manner.</li><li>Answer, screen, and direct incoming calls and assist with administrative tasks such as data entry, filing, and document preparation.</li><li>Post payments and adjustments.</li></ul>Qualifications<ul><li>Proven experience in medical billing and office administration within a healthcare setting.</li><li>Strong knowledge of medical terminology, medical records management, and insurance procedures.</li><li>Excellent bilingual communication skills in English and the second language; fluency is highly preferred.</li><li>Proficiency in Microsoft Office (Word, Excel, Outlook) and general office software.</li><li>Detail-oriented with strong organizational skills to handle multiple tasks efficiently. Join our team where your expertise makes a difference! We are committed to fostering an inclusive workplace that values your skills in medical billing, coding accuracy, and exceptional patient service. This paid position offers a rewarding environment where your contributions support quality healthcare delivery every day!</li></ul>Pay: $19.00 - $25.00 per hourBenefits:<ul><li>Health insurance</li><li>Paid time off</li></ul>People with a criminal record are encouraged to applyWork Location: In person

Bilingual Medical Biller/Receptionist

Mokan Sheet Metal Workers Welfare Fund

Provide high-level customer service while accurately processing Medical, Hospital, Dental, and ITS claims. Collaborate effectively with office staff in a team-oriented environment to ensure timely and accurate claim resolution. Maintain professionalism, attention to detail, and compliance with company policies while supporting both internal teams and customers.Job Type: Full-timePay: $23.00 - $25.00 per hourBenefits:<ul><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul>Physical Setting:<ul><li>Office</li></ul>Education:<ul><li>High school or equivalent (Preferred)</li></ul>Experience:<ul><li>Microsoft Office, Word, FACETS: 1 year (Required)</li><li>Customer Service/ FACETS: 1 year (Required)</li><li>Claims processing: 1 year (Required)</li></ul>Work Location: In person

Claims Processor

Urology Centers of Alabama

<div>General Summary
The Patient Account Representative will utilize the EMR and insurance systems to verify coverages and provide accurate information to allow for collection of all accounts. Maintain claims processing, including accurate and timely claim creation, follow-up and correspondence with insurance inquiries/correspondence. Assure payments are recorded and reconciled timely in order to maximize revenues. Counsels patients on financial matters to assure prompt payments are received for services.<div>
</div>Minimum Qualifications<ul><li>
Must demonstrate a working knowledge of CPT and ICD-10 coding systems. Knowledge of individual codes not required.
</li><li>Must demonstrate experience with verifying insurance eligibility, including with Alabama Medicaid&rsquo;s State Eligibility System.</li><li>
Must demonstrate sound knowledge of medical collection practices.
</li><li>Must show the ability to learn and understand an electronic medical record.</li><li>
Must show the ability to have excellent interpersonal skills and communication to interact with all walks of life, internal and external to UCA, from all educational or cultural backgrounds.
</li><li>Must show the ability to work independently or within a team in a fast-paced environment.</li><li>
Must show proficiency in use of a variety of office equipment including a PC, Windows, MSOffice, EMR system, multi-line telephone, copier, facsimile machine, etc.</li><li>
Must show the ability to maintain confidentiality, including strict adherence to HIPAA and UCA Guidelines.</li><li>
Must have a high school diploma or GED equivalent.</li></ul><div>
</div>Preferred Qualifications<ul><li>
May have an associate degree or higher in medical billing and coding.</li><li>
May have three (3) to five (5) years&rsquo; experience in healthcare billing claims.</li><li>
Show experience with Greenway or Allscripts EMR system.</li></ul><div>
</div>Licensure, Certification, Registration Requirements
None.<div>
</div>Supervisory Requirements
This position will not supervise any other staff members.<div>
</div>Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; stoop, kneel, crouch, or crawl; and talk or hear. The employee must occasionally lift and/or move more than 25 pounds.
Essential Functions<ul><li>
Prepares and submits clean claims to third party payers either electronically or by paper.</li><li>
Maintains relationship with clearinghouse, including appropriate follow-up with support issues.</li><li>
Coordinate the process of patient eligibility through various third-party sources.</li><li>
Coordinate collection process, to include any projects from Greenway accounts and tracking in soon to be collections in Allscripts.</li><li>
Maintain monthly statement process.</li><li>
Escalate patient issues to Director of Revenue Cycle.</li><li>
Work with reception staff, ensure appropriate collection of co-pays, deductible and self-pay fees.</li><li>
Handles patient inquiries and answers questions from clerical staff and insurance companies.</li><li>
Identifies and resolves patient billing problems.</li><li>
Denial and insurance follow-up management.</li><li>
Issues adjusted, corrected, and/or rebilled claims to third party payers.</li><li>
Posts adjustments transfer of responsibility and refunds, as necessary.</li><li>
Assure coding is compliant and up to date.</li><li>
Reviews accounts and makes recommendations to the Director regarding non collectible accounts.</li><li>
Other relevant duties as assigned.</li></ul></div>

Biller - FT

AllCare Management Services

<div>We Are Seeking Qualified Candidates to Join Our Team!
AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.
Summary of the Position
This position supports claims operations and financial integrity by performing a variety of administrative and department functions related to claims processing, system COB updates, and audit support. Responsibilities include managing Coordination of Benefits (COB) reporting, implementing updates within the EZ-CAP claims system, processing refunds and overpayment recoveries, and assisting with internal and external audit activities, including HSAG, OHA, CMS, and financial audits. The role also involves reviewing claims identified through monitoring reports, ensuring issues are researched and resolved appropriately, and supporting check run activities to help ensure accurate and timely provider payments. This position works collaboratively with all claims staff, finance, compliance, and IT teams to maintain efficient operations and ensure adherence to regulatory and organizational requirements.
Essential Duties 
1. Maintain and update Coordination of Benefits (COB) information, including reporting, verification, and system updates to ensure accurate claims processing 
2. Review, research, and process refund requests and overpayment recoveries, ensuring compliance with contractual, regulatory, and internal policies 
3. Provide departmental support for internal and external audits, including preparation of documentation and data requests for entities such as HSAG, CMS, and financial auditors 
 
Qualifications
Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
Education
High school diploma or general education degree (GED) required. College degree in an applicable field is preferred.
Experience
One to two years related experience and/or training in administrative and/or medical claims processing required. EZ-CAP claim processing system experience is highly preferred.
Certificates, Licenses, and/or Registrations 
This position does not require any certificates, licenses, or registrations. The following certifications are preferred for this job role: 
<ul><li>Certified Professional Coder (CPC)</li><li> 
Certified Clinical Medical Assistant (CCMA)</li><li>Certified Billing and Coding Specialist (CBCS)</li><li>Certified Medical Administrative Assistant (CMAA)</li><li>Certified Coding Specialist (CCS)</li></ul> 

Technical Skills 
<ul><li>Knowledge of and compliance with HIPAA regulations.</li><li>Proficient in data entry and use of claims management systems</li><li>Knowledge of Medicare and Medicaid, procedures, and regulatory requirements</li><li>Basic understanding of medical coding and billing practices</li><li>Strong attention to detail and ability to identify discrepancies or inconsistencies</li><li>Excellent organizational skills and ability to manage multiple tasks efficiently</li><li>Excellent communication skills, both written and verbal, for interaction with internal and external stakeholders</li><li>Exceptional writing, editing, and proofreading skills.</li><li>Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).</li><li>Skilled at breaking a project into definable and measurable tasks and tracking progress to completion.</li><li>Excellent customer service skills to respond appropriately and interact positively with upset customers.</li></ul>
Interpersonal Skills<ul><li>Reliable, confident, and effective in fostering positive relationships.</li><li>Demonstrates accountability, inspires trust, and connects well with colleagues.</li><li>Trustworthy, accountable, and skilled at collaborative engagement.</li></ul>
Language Skills 
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. 
 
Mathematical Skills
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Computer Skills
Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.
Reasoning Ability
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to work with problems involving a few concrete variables in standardized situations.
Physical Demands &amp; Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate. 
 
<ul><li>The employee must be able to work onsite, as needed.</li><li>The employee can work from a home office, occasionally.</li></ul> 
Company Overview
AllCare Health Website: https://www.allcarehealth.com.
AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp&reg; status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)
AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.
The AllCare Health family of businesses is guided by our corporate principles:
Purpose | Working together with our communities to improve the health and well-being of everyone.
Values | Trust, Innovation, Relationships, and Voice.
Vision | Thriving, Inclusive, and Equitable communities.
Brand Promise | Changing Healthcare to Work for You.
AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others.
If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information. 
699 - Claims Processing Assistant_March2026.pdf</div>

CLAIMS PROCESSING ASSISTANT

Chapters Health System

<div>It&rsquo;s inspiring to work with a company where people truly BELIEVE in what they&rsquo;re doing!
When you become part of the Chapters Health Team, you&rsquo;ll realize it&rsquo;s more than a job. It&rsquo;s a mission. We&rsquo;re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!
Hybrid position - remote 4 days a week and in office 1 day a week 
 
Role: 
The Accounts Payable Representative is responsible for ensuring accurate payments to vendors/providers which includes processing invoices/claims, conducting research, obtaining approval, recordkeeping, and maintaining vendor/provider relationships.<div>
Qualifications:<ul><li>
Minimum of one (1) year accounting experience to include General Ledger, AP, A/R or Financial Reporting</li><li>
For Patient Payables - preferred two (2) years experience in medical claims processing, medical biller or coder.</li><li>
Computer experience to include Microsoft (Outlook, Excel, Word) and Windows Explorer</li><li>
Team player and self-starter who is accurate and detail-oriented</li><li>
Professional attitude</li><li>
Highly organized, with the ability to effectively manage many tasks simultaneously</li><li>
Able to maintain a strict level of confidentiality</li><li>
Proficient in time management skills with the ability to prioritize a variety of duties and complete projects within assigned time frames</li></ul>
Competencies:<ul><li>
Satisfactorily complete competency requirements for this position.</li></ul>
Responsibilities of all employees:<ul><li>
Represent the Company professionally at all times through care delivered and/or services provided to all clients.</li><li>
Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.</li><li>
Comply with Company policies, procedures and standard practices.</li><li>
Observe the Company's health, safety and security practices.</li><li>
Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.</li><li>
Use resources in a fiscally responsible manner.</li><li>
Promote the Company through participation in community and professional organizations.</li><li>
Participate proactively in improving performance at the organizational, departmental and individual levels.</li><li>
Improve own professional knowledge and skill level.</li><li>
Advance electronic media skills.</li><li>
Support Company research and educational activities.</li><li>
Share expertise with co-workers both formally and informally.</li></ul></div><ul><li>
Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.</li></ul>
Job Responsibilities:
 Overhead Payables:<ul><li>
Process invoices/check requests using automated AP system</li><li>
Enters vouchers into AP system and reviews for accuracy. For employee expense reports, make sure all receipts are attached and adheres to policy.</li><li>
Assigns correct affiliate/GL account coding to each voucher.</li><li>
Assigns approver and submits for approval.</li><li>
Adds any voucher that requires special attention to the special handling log.</li><li>
For new vendors, obtains a copy of the vendors&rsquo; W-9 as well as ACH information for proper set-up into the system.</li><li>
Communicates with vendors and teams with regards to problems/questions concerning invoices.</li><li>
Updates all required logs.</li><li>
Reviews system queues/reports to ensure all invoices are being paid in a timely manner.</li><li>
Assists with annual 1099 process.</li></ul>
 Patient Payables:<ul><li>
Efficiently and accurately analyzes claim submissions to determine whether the claim should be accepted, rejected, approved or denied for payment based on the legally binding agreement and/or fee schedules and the patient conditions.</li><li>
Resolves pended claims, secondary review claims and prior approval requests.</li><li>
Reviews and addresses provider inquiries regarding claim adjudication, including incoming phone calls, correspondence, and appeals.</li><li>
Research requests for overpayment/underpayment efficiently and accurately, submit data and resolution to the supervisor for final determination.</li><li>
Maintains a thorough knowledge of third-party billing and reimbursement requirements.</li><li>
Ensure accurate record keeping of all vendors, including TIN, NPI, Physical Address, Remit Address and Vendor Contact person&rsquo;s email address and phone number.</li></ul>
Compensation Pay Range:
$17.89 - $25.76
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
All Chapters Health System employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse to verify eligibility after a conditional offer of employment is made as well as ongoing eligibility. For more information, please visit https://info.flclearinghouse.com/.</div>

Accounts Payable Representative

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