medical claims processor

Moda Health

<div>
 
 Let&rsquo;s do great things, together!
 
 
 
 
 About Moda
 
 
 
 Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we&rsquo;re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let&rsquo;s be better together.
 
 
 
 Position Summary
 
 
 
 Responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines as outlined by the company.
 
 This is a FT WFH role.
 
 
 
 
 Pay Range
 
 
 
 $17.34 - $19.41 hourly, DOE.
 
 
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 Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
 
 
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 Please fill out an application on our company page, linked below, to be considered for this position.
 
 
 
 https://j.brt.mv/jb.do?reqGK=27774713&amp;refresh=true
 
 
 
 Benefits
 
 
 
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 Medical, Dental, Vision, Pharmacy, Life, &amp; Disability
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 401K- Matching
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 FSA
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 Employee Assistance Program
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 PTO and Company Paid Holidays
 
 
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 Required Skills, Experience &amp; Education
 
 
 
 <ul>
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 High School diploma or equivalent
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 6-12 months data entry or medical office experience preferred
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 10-key proficiency of 135 spm
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 Type a minimum of 35 wpm
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 Knowledge of medical terminology, CPT codes and ICD-9/10 codes preferred
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 Demonstrates work habits that include punctuality, organization, and flexibility
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 Ability to maintain balanced performance in areas of production and quality
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 Analytical reasoning and flexibility
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 Professional and effective written and verbal communication skills
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 Experience with Facets platform a plus
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 Identify all the duties and responsibilities
 
 
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 Primary Functions
 
 
 
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 Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
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 Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
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 Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.
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 Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
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 Adjudication of claims to achieve quality and production standards applicable to this position.
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 Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
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 Reviews Policies and Procedures (P&amp;P&rsquo;S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
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 Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
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 Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda&rsquo;s standard workweek is a 37.5 hour work week.
 
 
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 Working Conditions &amp; Contact With Others
 
 
 
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 Office environment with extensive close PC and keyboard work with constant sitting. Must be able to navigate multiple screens. Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda&rsquo;s standard workweek is a 37.5 hour work week.
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 Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs.
 
 
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 Together, we can be more. We can be better.
 
 
 
 Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.
 
 
 For more information regarding accommodations, please direct your questions to Kristy Nehler &amp; Danielle Baker via our humanresources@modahealth.com email.
</div>

Medical Claims Processor I

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

Health Care Service Corporation

<div>
 At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
 
 
 Join HCSC and be part of a purpose-driven company that will invest in your professional development.
 
 
 Under Supervision, This Position Is Responsible For Processing Complex Claims Requiring Further Investigation, Including Coordination Of Benefits And Resolving Pended Claims.
 
 
 
 Required Job Qualifications
 
 
 
 <ul>
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 High School diploma or GED.
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 Data entry and/or typing experience.
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 Clear and concise written and verbal communication skills.
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 Experience processing medical claims.
 
 
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 Preferred Job Qualifications
 
 
 
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 Experience processing and reviewing claims.
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 Referral preference given to applicants able to take and meet testing criteria.
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 Must have the ability to fully complete the six-eight-week Blue Chip Training class.
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 Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
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 Knowledge of coordination of benefits principles and terminology.
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 Experience with multi-tasking and prioritizing.
 
 
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 THE STARTING PAYRATE FOR THIS ROLE IS $17.75/hr-$18.25/hr NON-NEGOTIABLE.
 
 
 
 Compensation: $17.75 - $26.17
 
 
 Exact compensation may vary based on skills, experience, and location
 
 
 
 HCSC Employment Statement
 
 
 
 We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
 
 
 To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
</div>

Claim Technician

Sequoia Family Medical Center

Job Summary: Our Billing Clerks are responsible for processing claims, collecting, posting, investigating, and resolving claims, accurately entering billing data, and submitting claims to insurance providers, including Medicare and Medical.Job Duties:<ul><li>Prepare, review, an transmit claims daily</li><li>Monitor submitted claims, follow up on unpaid claims, and work directly with insurance companies on rejected claims</li><li>Resubmit claims</li><li>Post and reconcile payments</li><li>Manage delinquent accounts</li><li>Provides timely and professional customer service, verify discrepancies, resolve patient billing issues, answer questions from patients, facility staff, and third-party vendors, identify and resolve patient billing complaints</li><li>Perform collection related tasks, such as contacting patients by phone</li><li>Collect daily route slips and disburse to billers for data entry</li><li>Adequately enter CPT codes and charges into the computer from route slips daily</li><li>Maintain daily production sheet on all providers and give copies to the accounting department, CFO, and Billing Supervisor</li><li>Review route slips for errors and give to supervisor to log and send back to provider or staff for corrections</li><li>Review insurance eligibility is valid and active</li><li>Work aging reports</li><li>Assist in end of month process</li><li>Answer incoming calls</li><li>Work independently with direction from Billing Supervisor</li><li>Maintain the strictest confidentiality; adhere to all HIPAA guidelines/regulations</li></ul>JOB REQUIREMENTS:<ul><li>Knowledge of medical terminology</li><li>Competent use of computer systems and Microsoft Office Suites</li><li>Familiarity with CPT and ICD-10 Coding</li><li>Strong customer service, analytical, and problem-solving skills</li><li>Knowledge of insurance guidelines</li><li>Ability to work under pressure.</li><li>Ability multi-task</li><li>Ability to effectively communicate with patients</li></ul>Minimum Qualifications:<ul><li>High School Diploma required.</li><li>Certificate in Medical Administration, Medical Billing/Coding program or equivalent experience in similar role is highly preferred.</li><li>Bilingual in English/Spanish (preferred)</li></ul>Job Type: Full-timePay: $17.50 - $23.50 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Application Question(s):<ul><li>What is your hourly salary expectation?</li><li>Did you graduate from a Medical Office Administration or Medical Billing/Coding program?</li></ul>Education:<ul><li>High school or equivalent (Preferred)</li></ul>Experience:<ul><li>Medical Billing &amp; Coding: 1 year (Preferred)</li></ul>Work Location: In person

Medical Billing Clerk

Emergicon, LLC

<div><div><div>We are looking for experienced billers to join our billing team. In this role, you&rsquo;ll help EMS organizations by ensuring accurate, timely billing while enjoying opportunities for professional growth and development.</div></div>
This position is responsible for researching, coding, and filing accurate claims in a timely manner while ensuring compliance with payer and regulatory requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES<ul>
<li>Obtain all run reports (trip notes, PCRs, etc.) by paper or electronically for previous days&rsquo; transports
</li><li>Code claims with appropriate ICD-10 and HCPC codes
</li><li>Review each chart for medical necessity
</li><li>Request hospital face sheet/demographics, if applicable, to obtain payer or demographic information
</li><li>Verify payer information on all transports
</li><li>Check appropriate insurance websites and/or contact the patient on all private pay accounts prior to billing
</li><li>Enter all claims into the billing system
</li><li>Match claims billed against all appropriate logs
</li><li>Follow up on rejected and failed claims as needed
</li><li>Recognize payer trends and report to management
</li><li>Perform other job-related duties as assigned
</li></ul>EDUCATION AND EXPERIENCE<ul>
<li>High school diploma or GED required
</li><li>Minimum of six (6) months of medical billing experience required
</li><li>EMS billing experience preferred
</li><li>Six months of ICD-10 and HCPC coding experience required
</li><li>CAC certification preferred
</li></ul>KNOWLEDGE, SKILLS, AND ABILITIES<ul>
<li>Strong attention to detail and accuracy
</li><li>Effective verbal communication skills
</li><li>Professional phone etiquette
</li><li>Ability to maintain any certification applicable to job functions
</li><li>Strong organizational skills with a focus on meeting deadlines
</li></ul>PHYSICAL REQUIREMENTS 
This position involves extended periods of sitting or standing at a desk while working on a computer and performing repetitive tasks. Occasional lifting of up to 10 pounds may be required.
Emergicon requires satisfactory pre-employment background check and drug screening.</div>

Medical Biller

Blue Cross and Blue Shield of Louisiana

<div>We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.<div>
POSITION PURPOSE
Duties may include the following responsibilities or functions required to support the claims unit. Accurate processing of claims edits, determining primacy for the Coordination of Benefits (COB), adjusting previously paid claims and initiating procedures to recover funds on overpaid claims. Analyzing, investigating, and resolving problem cases; executing recovery processes; and completing special projects. Accountable for complying with all laws and regulations that are associated with duties and responsibilities.</div><div>
NATURE AND SCOPE<ul><li>
This role does not manage people</li><li>
This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS</li><li>
Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist II must be in contact with personnel in other Units: Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Enrollment and Billing, Administrative Services, and District Offices. Various external entities including, but not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans.</li></ul></div><div>
QUALIFICATIONS 
 
Education<ul><li>
High School Diploma or equivalent required
</li></ul>Work Experience<ul><li>
2 years in medical claims processing required
</li><li>Coordination of Benefits (COB) processing experience preferred
</li></ul>Skills and Abilities<ul><li>
Strong analytical ability, that includes strong logical, systemic, and investigates thinking.
</li><li>Strong oral and written communication skills and human relations skills are necessary.
</li><li>Working knowledge of relevant PC software.
</li><li>Ability to prioritize multiple streams of work effectively.
</li></ul>Licenses and Certifications 
<ul><li>
None Required</li></ul></div><div> 
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS<ul><li>
Reviews, researches, and makes necessary updates to claims that may include the following: recalculation of benefits to previously processed claims, the processing of claims edits, or initiation of refund requests, according to contractual benefits or provider reimbursement rules, ultimately providing a high degree of customer satisfaction.
</li><li>Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims (including our coordination with additional coverage plans) in order to process both coordinated and non-coordinated claims correctly. Requesting of medical records may be required.
</li><li>Communicates, both orally and in writing, with internal and external contacts in order to provide necessary and accurate information for the establishment of sound claim records. This may include, but is not limited to, the coordination of benefits (COB), medical record requests, etc.
</li><li>Review quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction.
</li><li>Researches, investigates, and determines the correct order of benefits for payment to be made by the applicable plans and makes necessary corrections to COB records. Communicates to appropriate department(s) when Medicare has determined primacy incorrectly and ensures a letter is generated to notify Medicare. Failure to report discrepancy could result in a daily fine up to $1,000.00.
</li><li>Analyzes, investigates, resolves problem cases (to include COB records, adjusting previously processed claims and requesting refund of overpaid claims). Reviews all previously processed claims to ensure consistency in payments to maximize recovery of overpayments following corporate and departmental guidelines to ensure financial stability.
</li><li>Executes procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processing and financial stability.
</li><li>Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation).
</li><li>May complete special projects as assigned by Management due to internal audit findings, multiple provider status changes, and system errors following corporate and departmental guidelines to ensure financial stability and customer satisfaction.
</li></ul>Additional Accountabilities and Essential Functions 
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions<ul><li>
Perform other job-related duties as assigned, within your scope of responsibilities.
</li><li>Job duties are performed in a normal and clean office environment with normal noise levels.
</li><li>Work is predominately done while standing or sitting.
</li><li>The ability to comprehend, document, calculate, visualize, and analyze are required.
</li></ul></div>An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the &quot;My Applications&quot; section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.</div>

Claims Specialist II

United Medical Management

Job Summary: We are seeking a skilled and detail-oriented Medical Biller to join our team. As a Medical Biller, you will be responsible for accurately coding and billing medical claims, ensuring timely reimbursement from insurance companies. Your expertise in medical terminology, coding systems, and medical records will be crucial in this role.Duties: - Review and analyze medical records to accurately assign appropriate codes for diagnoses, procedures, and services rendered - Ensure compliance with coding guidelines and regulations, such as ICD-9, ICD-10, and DRG - Prepare and submit claims to insurance companies electronically or by paper - Follow up on unpaid or denied claims, identifying and resolving any issues or discrepancies - Communicate with insurance companies to verify coverage, obtain pre-authorizations, and resolve billing inquiries - Collaborate with healthcare providers to ensure accurate documentation of services rendered - Maintain patient confidentiality and adhere to HIPAA regulations - Stay updated on changes in coding regulations and guidelinesExperience: - Proven experience as a Medical Biller or in a similar role - Proficiency in medical terminology, coding systems (ICD-9, ICD-10), and medical billing software - Knowledge of medical collection processes and insurance claim procedures - Familiarity with electronic health records (EHR) systems - Strong attention to detail and accuracy in coding and billing processes - Excellent communication skills to interact with healthcare providers, insurance companies, and patientsNote: All positions must be paid including internship positions.Job Type: Part-timePay: $19.00 - $24.00 per hourBenefits:<ul><li>Paid time off</li></ul>Work Location: In person

Medical Biller and Claims Specialist

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