<p>We are looking for a detail oriented Entry-level Claims Representative to join our clients' team in Ontario, California. In this role, you will provide critical support in managing claims-related tasks, ensuring accuracy and efficiency in processing, reconciling, and auditing claims. This is a long-term contract position ideal for professionals with strong organizational skills and a background in medical office operations.</p><p><br></p><p>Responsibilities:</p><p>• Match checks with remittance advice, prepare and insert them into envelopes for mailing.</p><p>• Reconcile processed batches within the audit database to ensure accuracy.</p><p>• Create and mail denial trailers and letters to providers.</p><p>• Print and send out claim requirement letters for Covered California members.</p><p>• Forward claims to the appropriate health plan when necessary.</p><p>• Process and mail claims deemed unable to process, including generating the necessary correspondence.</p><p>• Batch trailers created by various departments and ensure proper documentation.</p><p>• Audit the batch log key to confirm claims have been assigned and logged correctly.</p><p>• Verify member information to determine line of business and coordination of benefits in the system.</p><p>• Collaborate on process adjustments and work independently or as part of a team.</p>
We are seeking a detail-oriented Medical Billing Collections Specialist to join our team and ensure accurate and timely management of claims for Skilled Nursing Facility services. As a key contributor to the revenue cycle, you'll handle critical tasks such as claims submission, denials management, and appeals, while ensuring compliance with Medicare, Medi-Cal, and other insurance guidelines.<br><br>Key Responsibilities:<br><br>Claims Submission: Accurately and promptly prepare and submit claims to insurance payers for Skilled Nursing Facility services.<br>Denials Management: Review denied claims, identify root causes, and implement corrective actions to minimize future denials.<br>Appeals: Draft and submit effective appeals for claim denials to secure appropriate reimbursements.<br>Billing Accuracy: Maintain detailed, accurate patient records, ensuring compliance with Medicare, Medi-Cal, and payer-specific requirements.<br>Follow-Up: Communicate with insurance companies and other payers to resolve outstanding claims and secure timely reimbursements.<br>Regulatory Compliance: Stay informed and ensure adherence to all federal, state, and local billing regulations, including compliance with HIPAA.<br>Collaboration: Work closely with administrative and clinical teams to optimize billing workflows and integrate documentation processes.<br>Reporting: Generate clear, actionable account reports showing billing trends, claim statuses, and resolution timelines for management review.
We are looking for a skilled Medical Collections Specialist to join our team in Irvine, California. This is a Contract-to-Permanent position, offering an excellent opportunity to grow your career in a dynamic healthcare environment. The ideal candidate will play a vital role in managing accounts receivable, resolving payment discrepancies, and ensuring compliance with industry regulations.<br><br>Responsibilities:<br>• Manage accounts receivable by following up on outstanding payments, payment errors, and claim denials.<br>• Analyze insurance Explanation of Benefits (EOBs) and initiate appeals when necessary to resolve discrepancies.<br>• Maintain detailed documentation of account issues, resolutions, and follow-up actions for patient records.<br>• Prepare and send required documentation via mail or other channels to support claims processing.<br>• Stay informed about commercial and managed care pricing models, as well as relevant rules and regulations.<br>• Ensure compliance with organizational policies and healthcare laws, safeguarding patient confidentiality at all times.<br>• Participate in compliance training sessions and promptly report any concerns or incidents to management.<br>• Utilize systems such as EHR platforms, Epic Software, and IBM AS/400 to ensure efficient claims and collections processes.<br>• Support the team by performing additional tasks as directed by supervisors or management.<br>• Contribute to the overall success of the department by collaborating with colleagues to meet organizational goals.
<p>A well-established <strong>manufacturing company in Vista</strong> is seeking a knowledgeable and proactive <strong>Human Resources Generalist</strong> to support their production facility. This position plays a critical role in employee relations, compliance, and talent support for a workforce of both office and production employees.</p><p><br></p><p><strong>Responsibilities:</strong></p><ul><li>Administer HR policies and procedures while ensuring compliance with California labor laws and OSHA requirements.</li><li>Partner with supervisors to handle performance reviews, corrective actions, and investigations.</li><li>Oversee recruitment, onboarding, and orientation for hourly and salaried positions.</li><li>Maintain employee files, I-9 documentation, and training certifications.</li><li>Coordinate benefits enrollment, workers’ compensation claims, and leave of absence management.</li><li>Conduct safety and compliance audits; support the Safety Committee with reporting and documentation.</li><li>Support payroll processing and timecard review in partnership with accounting.</li><li>Promote positive employee engagement through communication and recognition programs.</li></ul>
<p>We are looking for a detail-oriented Personal Injury Plaintiff Case Manager to join our team in Los Angeles, California. In this role, you will oversee personal injury cases, ensuring efficient claim processing, effective communication, and timely management of client needs. The ideal candidate will have a strong background in case management and a commitment to delivering exceptional client service.</p><p><br></p><p>Responsibilities:</p><p>• Process and open health insurance claims with accuracy and attention to detail.</p><p>• Upload and organize critical documents into the company’s case management software.</p><p>• Schedule and coordinate medical appointments while maintaining an up-to-date calendar.</p><p>• Serve as the primary point of contact for clients, addressing their concerns promptly and professionally.</p><p>• Ensure proper documentation and tracking of case details to support smooth claim administration.</p><p>• Collaborate with internal teams to streamline workflows and maintain case progress.</p><p>• Utilize CRM tools to manage client interactions and maintain detailed records.</p><p>• Monitor case timelines and ensure all deadlines are met.</p><p>• Stay informed about personal injury law and regulations to provide informed support.</p><p>• Maintain confidentiality and adhere to legal compliance standards.</p>
<p>We are looking for a skilled Claims Specialist to join our team in Los Angeles, California. . The ideal candidate will bring expertise in managing workers' compensation claims and ensuring seamless communication between all parties involved.</p><p><br></p><p>Responsibilities:</p><p>• Manage a portfolio of modified duty and lost time claims with efficiency and accuracy.</p><p>• Forward medical records related to workplace injuries to the appropriate insurance adjuster.</p><p>• Input data from medical records into the system while maintaining attention to detail.</p><p>• Notify supervisors of initial diagnoses and work status for injured employees.</p><p>• Support the Hospital Manager and injured employees in implementing early return-to-work programs.</p><p>• Schedule and track follow-up doctor appointments, ensuring medical statuses are documented within 24 hours of each visit.</p><p>• Communicate appointment outcomes to insurance adjusters and supervisors promptly.</p><p>• Monitor lost time and modified work data, updating the system regularly.</p><p>• Maintain regular communication with insurance adjusters, providing updates at least every 60 days until claims are resolved.</p><p>• Conduct audits of claim data and related records consistently to ensure accuracy</p>
We are looking for a skilled Case Manager to join our team in Encino, California. In this role, you will oversee multiple pre-litigation cases, ensuring prompt and effective resolution while providing exceptional support to clients. This is an onsite position that offers a dynamic work environment and opportunities for growth.<br><br>Responsibilities:<br>• Manage multiple pre-litigation cases, ensuring timely and effective resolution.<br>• Supervise and guide entry-level case managers in their daily tasks and responsibilities.<br>• Facilitate claims processing with insurance carriers, including health insurance, Medicare, and Medi-Cal.<br>• Coordinate property damage and loss of use claims, ensuring proper resolution.<br>• Identify healthcare providers and schedule medical appointments for injury treatment.<br>• Advocate for clients by monitoring their medical treatment and arranging necessary care based on provider recommendations.<br>• Review, analyze, and interpret medical records, surgical reports, and medical bills.<br>• Prepare case files and documentation for submission to the demands department.<br>• Communicate effectively with clients, healthcare providers, and internal staff to maintain a high level of service.
<p>A Surgery Center in Los Angeles is in the need of a Surgery Medical Billing Collections Specialist. The Surgery Medical Billing Collections Specialist must have at least 2 years of experience in the healthcare industry. The Surgery Medical Billing Collections Specialist must be able to work review aged EOBs and resolve denials.</p><p>DUTIES AND RESPONSIBILITIES</p><p>-Performs full cycle billing and collection functions for OHMG Surgical detail-oriented fees.</p><p> -Verify patient eligibility, authorization status and primary payer information via CareConnect and Insurance portals prior to claim submission.</p><p> -Performs all data entry and charge posting functions for OHMG services as needed -Performs all third-party follow-up functions for all products and OHMG surgical procedures.</p><p> -Reviews EOBS and Denials. Make corrections as required and resubmit the claim for payments.</p><p> -Work on the Athena Work Dashboard / Claim list on a daily basis for all services assigned.</p><p> -Performs daily review of Urgent Care provider chart notes to assure that documentation is complete and supportive of submitted charges prior to billing.</p><p>-Provides the correct ICD-10M code to identify the provider's narrative diagnosis -Provides the correct HCPCS code to identify medications and supplies.</p><p> -Provides the correct CPT code to accurately identify the services performed based on the provider's documentation.</p><p>- Reviews all surgical operative reports and assigns appropriate CPT codes and ICD-10-CM codes for services performed by staff surgeons.</p>
<p>Are you an experienced Medical Biller/Collector with strong leadership skills and a passion for solving complex billing issues? Join a dynamic team as our next <strong>Lead Medical Biller Collector</strong>! We are seeking a driven professional with hands-on experience in medical billing and collections, appeals, denials management, and overseeing a high-performing team.</p><p><strong>Key Responsibilities:</strong></p><ul><li>Lead and assist in overseeing a team of medical billers and collectors, providing mentorship and ensuring optimal team performance.</li><li>Actively contribute to the day-to-day production of billing and collections processes.</li><li>Manage and resolve all aspects of insurance denials, including appeals and root-cause analysis.</li><li>Collaborate with team members to create strategies that minimize denials and optimize operational workflows.</li><li>Work with Medi-Cal, Medicare, and Commercial medical insurance payers to ensure timely and accurate claim submissions and payments.</li><li>Stay informed of changes in insurance guidelines and compliance requirements</li></ul><p><strong>Qualifications:</strong></p><ul><li>Proven experience in a medical billing and collections role, including leading or assisting in managing a team.</li><li>Hands-on expertise in insurance appeals, denials management, and identifying root causes of claim denials.</li><li>In-depth experience working with Medi-Cal, Medicare, and Commercial insurance providers.</li><li>Strong knowledge of medical billing systems and coding practices (CPT, ICD-10, HCPCS).</li><li>Excellent problem-solving, organizational, and communication skills.</li><li>Ability to work both independently and collaboratively in a remote environment.</li></ul><p><br></p><p><br></p>
<p>Nationally recognized hospital system is seeking a dedicated and experienced <strong>Medical Insurance Collections Specialist</strong> to join our dynamic team. In this critical role, you will be responsible for handling insurance collections, ensuring accurate claims processing, and collaborating with internal departments to resolve outstanding accounts. This is an excellent opportunity for a detail-oriented professional who thrives in a fast-paced healthcare environment.</p><p><strong>Key Responsibilities:</strong></p><ul><li>Review patient accounts to identify unpaid claims and follow up with insurance providers for resolution.</li><li>Resolve denials and claim discrepancies by researching and resubmitting claims where necessary.</li><li>Communicate with patients and insurance companies regarding outstanding balances and payment plans.</li><li>Maintain accurate and up-to-date records of all collections activities in compliance with company policies and healthcare regulations.</li><li>Collaborate with the billing, coding, and accounts receivable teams to address any billing issues and expedite payments.</li><li>Analyze insurance claims to identify trends, minimize denials, and maximize collections efficiency.</li><li>Ensure compliance with HIPAA and all applicable regulations in handling sensitive healthcare and financial information.</li></ul><p><br></p>
<p>Are you a detail-oriented professional with expertise in denials management and medical collections? We are seeking a <strong>Clinical Appeals Medical Collector</strong> to join our team remotely! The ideal candidate will be experienced in handling denials, appeals, and working with various insurance payers, including HMO, PPO, Medicare, and Medi-Cal. If you thrive in a fast-paced environment and are ready to make an impact, this position is for you!</p><p><strong>Key Responsibilities:</strong></p><ul><li>Manage insurance denials and appeals with precision and timeliness.</li><li>Analyze denied claims and identify root causes to reduce future occurrences.</li><li>Submit detailed and comprehensive appeals to insurance providers (HMO, PPO, Medicare, Medi-Cal) to secure payment.</li><li>Stay up-to-date with payer policies and procedures to ensure compliance.</li><li>Collaborate with healthcare providers, payers, and internal team members for resolution of outstanding accounts.</li><li>Maintain accurate documentation of claims and communications.</li></ul><p><br></p>
<p><strong>Firm seeks Coverage Opinion Writing Attorney (No Litigation)</strong></p><p><br></p><p>This Attorney opening involves working closely with insurers to provide expert advice and analysis on insurance coverage matters. The ideal attorney will have a deep understanding of various insurance policies and be adept at drafting comprehensive coverage opinions.</p><p><br></p><p>Key Responsibilities:</p><ul><li>Collaborate with insurers to provide advice on insurance coverage and interpret policies.</li><li>Analyze various types of insurance policies across an array of industries.</li><li>Draft detailed coverage opinions based on policy analysis and contract interpretation.</li><li>Maintain effective communication with clients and internal team members.</li></ul><p><br></p><p>Billable hour target: 1850/year</p><p><br></p><p>Can work 100% remote in US (PST work hours)</p><p><br></p><p><u>Perks of Firm</u>:</p><ol><li>Established for over 30 years</li><li>Multiple offices with large firm resources</li><li>Women-owned firm</li></ol><p><br></p>
<p>About the Role:</p><p> We’re seeking a detail-oriented and efficient Cash Poster to join our team at a busy Ambulatory Surgery Center. This role is essential to ensuring accurate posting of all incoming payments, adjustments, and denials from both insurance payers and patients. The ideal candidate will have a strong understanding of the revenue cycle and a commitment to maintaining accuracy and timeliness in all financial transactions.</p><p><br></p><p>Key Responsibilities:</p><ul><li>Accurately post insurance and patient payments, adjustments, and denials to the appropriate accounts.</li><li>Reconcile daily deposits and ensure all payments are balanced.</li><li>Research and resolve payment discrepancies or posting errors.</li><li>Maintain detailed records of all posted payments.</li><li>Collaborate with billing, collections, and accounting teams to ensure accurate revenue reporting.</li><li>Review remittance advice (EOBs) and verify payment accuracy against contracted rates.</li><li>Assist with month-end close and audit preparation as needed.</li></ul><p><br></p>
We are looking for a skilled Billing Specialist to join our team in Irvine, California. This Contract-to-Permanent position is ideal for candidates with a strong background in billing, accounts receivable, and collections, along with proficiency in QuickBooks Enterprise. The role requires attention to detail and the ability to manage financial processes efficiently.<br><br>Responsibilities:<br>• Process and post credit card transactions and deposits accurately.<br>• Manage accounts receivable and oversee collections activities effectively.<br>• Perform bank reconciliations and ensure accuracy in financial records.<br>• Utilize QuickBooks Enterprise to maintain and update billing information.<br>• Handle daily deposits, including cash, checks, and electronic payments.<br>• Prepare and send billing statements to clients in a timely manner.<br>• Investigate and resolve discrepancies in account balances or transactions.<br>• Collaborate with team members to streamline billing processes and improve efficiency.<br>• Ensure compliance with company policies and financial regulations.
