Find & Apply For Billing Clerk / Specialist Jobs in Carmel-by-the-Sea, California

We are seeking a detail-oriented Medical Denials Specialist to join our healthcare revenue cycle team. This role is responsible for reviewing, researching, and resolving denied or underpaid medical claims to support timely reimbursement and reduce revenue loss. The ideal candidate has strong knowledge of payer guidelines, appeals processes, and healthcare billing workflows.

Hours:

Monday - Friday 8am -5pm

Key Responsibilities:

Review denied, rejected, or underpaid insurance claims and identify root causesInvestigate payer denials related to coding, authorizations, eligibility, timely filing, medical necessity, and billing errorsPrepare and submit appeals with appropriate supporting documentationCommunicate with insurance carriers, patients, providers, and internal departments to resolve claim issuesMonitor and track denial trends and escalate recurring issues for process improvementMaintain accurate and detailed account documentation in billing and practice management systemsFollow up on outstanding appeals and denied claims to ensure timely resolutionPartner with billing, coding, and patient access teams to reduce future denialsEnsure compliance with payer requirements, HIPAA, and internal policies