Responsible for resolving inquiries related to claims, eligibility, and authorization while working with multiple parties to keep records up to date.
Ensures first-call-resolution standards are followed and escalates or follows up as needed according to Hoag guidelines.
Supports revenue cycle and clinic MSO operations by maintaining databases, auditing information, processing patient payments, following up on unpaid claims, and assisting with patient statements.
Handles approximately 35–40 daily calls from healthcare providers, health plans, billing companies, and members regarding claims, eligibility, and authorization.
Documents all incoming calls and correspondence following HIPAA guidelines.
Supports the claims team with mailroom processing, claim receipts, correspondence handling, mail distribution, and sending provider EOBs, member letters, and other claims-related communications.
Assists in identifying process issues and supporting initiatives to improve claims processing efficiency.
Provides customer service to providers, members, health plans, and other stakeholders in a professional and collaborative manner.
High school diploma or equivalent.
At least 1 year of experience in medical claims or billing processing, or claims customer service in a health plan, medical group, or IPA environment.
Knowledge of HMO and managed care regulatory guidelines.
Proficiency in Microsoft Word, Excel, typing, and data entry.
Experience with medical billing protocols including HCPCS, ICD-10, and CPT codes.
EMR system experience preferred.
Preferred experience with Epic Tapestry CRM and claims adjudication.
Working knowledge of managed care regulatory guidelines, claims processing, and code categories.
Location
California, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
2 weeks ago