<p>Our team is seeking a Medical Insurance Collections Specialist with prior hospital experience to join a dynamic healthcare organization. In this role, you will play a critical part in maximizing hospital revenue by managing insurance denials, processing appeals, and handling collections related to HMO/PPO insurance claims. A strong understanding of UB-04 billing practices is required.</p><p>Key Responsibilities:</p><ul><li>Review and analyze insurance denials and identify appropriate action steps for appeal or resubmission.</li><li>Prepare and submit timely, thorough appeals using clinical and financial data.</li><li>Navigate and resolve issues related to HMO/PPO insurance programs.</li><li>Complete and accurately review UB-04 forms for billing and appeals processes.</li><li>Communicate with insurance carriers to gather status updates and clarify payment issues.</li><li>Collaborate with hospital billing and patient accounts teams to resolve outstanding balances.</li><li>Document all actions and maintain compliance with HIPAA and hospital policies.</li></ul><p><br></p>
<p>The Medical Biller & Collections Specialist is responsible for managing the full revenue cycle process to ensure timely and accurate reimbursement for services rendered. This role supports the financial health of the organization by overseeing insurance billing, payment posting, and patient account follow-up while maintaining strict compliance with healthcare regulations.</p><p><br></p><p>The specialist prepares, submits, and monitors insurance claims to commercial payers, Medicaid, and other applicable programs, ensuring claims are accurate, complete, and compliant with payer requirements. They research and resolve denied or underpaid claims, submit appeals when necessary, and communicate effectively with insurance companies to secure proper reimbursement.</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li>Submit, review, and track medical claims for timely reimbursement</li><li>Post insurance and patient payments accurately</li><li>Investigate and resolve claim denials, rejections, and underpayments</li><li>Submit appeals and supporting documentation as required</li><li>Manage patient balances, collections, and payment plans</li><li>Communicate with insurance carriers and patients regarding billing inquiries</li><li>Maintain accurate billing records and documentation</li><li>Ensure compliance with HIPAA and payer guidelines</li></ul>
We are looking for an experienced Claims Specialist to join our team in Los Angeles, California. In this role, you will focus on managing workers' compensation claims while ensuring compliance with medical management processes and communication protocols. This is a Contract to Permanent position, offering a dynamic opportunity to contribute to a service-driven organization.<br><br>Responsibilities:<br>• Manage a portfolio of modified duty and lost time claims, ensuring accurate and timely updates.<br>• Coordinate the forwarding of work-related injury medical records to insurance adjusters.<br>• Input medical record data into the system and communicate initial diagnoses and work statuses to supervisors.<br>• Assist injured employees and hospital managers in implementing early return-to-work programs.<br>• Schedule follow-up medical appointments and ensure documented medical statuses are secured within 24 hours of each appointment.<br>• Relay outcomes of medical appointments to supervisors and insurance adjusters within 24 hours of receipt.<br>• Monitor lost time and modified work statuses in the system, maintaining accurate tracking.<br>• Maintain regular communication with insurance adjusters every 60 days until claims are resolved.<br>• Conduct audits of claim data and related information to ensure accuracy and compliance.<br>• Perform monthly audits on organization-related data to support operational efficiency.
The Medical Billing Support Services Associate I coordinate and performs all aspects of the processing of cash receipts from automated and manual payers in accordance with training materials, scripts, and standard operating procedures. Position also performs a variety of duties which may include reviewing overpayments, credits and recoupments. Making phone calls and/or using payers web portals to check patient eligibility or confirming status of pending recoupments. This role is a Hybrid Remote role. Candidate must live with in Los Angeles County. <br>Essential Duties:<br>• Understand the practice billing and collection system and process requirements for the automated and manual cash posting, batch balancing and reconciliation of cash receipts in the insurance billing process.<br>• Researches and analyzes un-posted cash on hand and unapplied cash to ensure timely posting and resolution.<br>• Investigate unapplied cash receipts and resolve or escalate in a timely manner to lead or supervisor.<br>• Reverses balance to credit or debit if charges were improperly billed.<br>• Contacts insurance carriers as necessary to determine correct payment application.<br>• Reviews correspondences related to refunds and or recoupments. Takes the necessary actions such as issuing a refund request or sending a dispute/appeal to the payer.<br>• Responsible for evaluating credit balances and ensuring that refunds are issued to the appropriate payer in a timely and accurate manner.<br>• Work with Finance and other Revenue Cycle Departments to optimize the cash posting, balancing and reconciliation process.<br>• Communicates issues related to payment posting and refunds from payers to management.<br>• Updates correct payer and resubmits claims to the payers.<br>• Consistently meets/exceeds productivity and quality standards.<br>• Cross trained and performs billing processes such as charge entry, insurance verification of eligibility and ensuring correct payer is billed, reviewing, and resolving billing edits from worklists.<br>• Cross trained and performs customer service duties as such as answering patient phone calls, patient email inquiries or division email inquiries related to patient balances.<br>• Contacting insurance payers on behalf of the patient and or with the patient on the call to resolve patient responsibility concerns. Review and resolve self-pay credit balances.<br>• Special projects assigned by leadership for example annual audits, escheatment reviews, payer projects, compliance monthly audits.<br>• Special billing and collections for LOAs.<br>• Special billing and collections for Case Rates.<br>• Special billing and collections for Embassy Services.<br>• Performs other related duties as assigned by management team.
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 Hospital in Los Angeles is in the need of a Medical Billing Support Services Associate to join its healthcare team in Los Angeles. In this role, the Medical Billing Support Services Associate will play a crucial part in ensuring the accurate processing of cash receipts, managing patient eligibility reviews, and resolving recoupment statuses. The Medical Billing Support Services Associate must have strong background in medical billing and a commitment to excellence.</p><p><br></p><p>Responsibilities:</p><p>• Process cash receipts from both automated and manual payers, ensuring compliance with established procedures.</p><p>• Research and analyze unposted or unapplied cash to facilitate timely resolution and posting.</p><p>• Investigate unapplied cash receipts and escalate issues to supervisors when necessary.</p><p>• Reverse balances and adjust credits or debits to correct billing errors and payment applications.</p><p>• Review correspondence related to refunds or recoupments, taking appropriate actions such as issuing refund requests or submitting disputes.</p><p>• Evaluate credit balances and issue refunds to payers in an accurate and timely manner.</p><p>• Collaborate with Finance and other Revenue Cycle departments to streamline cash posting, balancing, and reconciliation processes.</p><p>• Address issues related to payment postings or refunds and communicate updates to management.</p><p>• Cross-train in billing processes, including charge entry, insurance eligibility verification, and resolving billing edits.</p><p>• Assist with special projects assigned by leadership, such as audits, payer compliance reviews, and case-specific billing and collections.</p>
