Description A hospital in Los Angeles is seeking an experienced Medical Insurance Denials Specialist to join its revenue cycle team. The Medical Insurance Denials Specialist will focus on insurance follow-up and collections for HMO and PPO payers, with an emphasis on resolving outstanding balances, researching claim issues, and securing timely reimbursement. The ideal Medical Insurance Deniasl Specialist candidate will also have experience working with UB04 claims in a hospital setting.

Key Responsibilities:

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+ Perform insurance collections follow-up on outstanding hospital claims with a focus on HMO and PPO payers.

+ Contact insurance companies and payers to obtain claim status, secure payment, and resolve unpaid or underpaid accounts.

+ Review and work hospital UB04 claims to ensure accurate billing and proper reimbursement..

+ Investigate and resolve claim denials, rejections, underpayments, and payment delays.

+ Submit corrected claims, supporting documentation, and appeals as needed to facilitate payment resolution.

+ Follow up on aged accounts receivable and maintain productivity in line with departmental goals.

+ Document all collection activity, account updates, and payer communications in the billing system.

+ Collaborate with billing, coding, and patient financial services teams to resolve claim discrepancies and improve reimbursement outcomes.

+ Monitor payer trends and escalate recurring issues impacting collections. Requirements

• At least 3 years of experience in medical insurance collections, insurance follow-up, or healthcare accounts receivable.
• Prior hospital billing or hospital collections experience is required.
• Hands-on experience working with UB04 claims in a hospital setting.
• Strong understanding of payer policies, reimbursement practices, denial management, and appeals processing.
• Ability to investigate claim issues, resolve underpayments, and follow through on outstanding balances in a high-volume environment.
• Solid organizational skills with strong attention to detail and the ability to manage multiple accounts efficiently.
• Effective written and verbal communication skills with a solution-oriented approach to problem solving.
• Experience using hospital billing platforms and electronic medical record systems is preferred.

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