Job Summary The Claims Specialist is responsible for managing the full cycle of insurance claims, including verification, submission, tracking, and resolution of claims with third-party payers. This role ensures timely reimbursement by reviewing claim accuracy, correcting denials, coordinating with insurance representatives, and maintaining compliance with payer guidelines and regulatory requirements. The Claims Specialist acts as a liaison between patients, providers, and insurance carriers to resolve claim issues and secure payment. Strong knowledge of insurance claims processes, including billing codes (ICD-10, CPT/HCPCS, revenue codes) and payer requirements. Familiarity with EOBs, ERAs, denial codes, and appeals processes. Excellent organizational skills and ability to manage multiple claims simultaneously. Strong written and verbal communication skills with payers, patients, and internal teams. Ability to work independently in a fast-paced, deadline-driven environment. Preferred Qualifications Experience working in an agency environment. Basic understanding of health insurance and facility claims. Experience with medical billing software/EMRs (e.g., Kipu, CollaborateMD, Availity). Prior experience working with behavioral health or medical claims. Knowledge of state and federal insurance regulations, including HIPAA and CMS guidelines. Key Responsibilities Verify patient insurance eligibility, benefits, and coverage prior to claims submission. Accurately prepare, submit, and track claims to third-party payers. Monitor pending claims and follow up with insurance companies to ensure timely processing. Review and resolve denied or rejected claims; submit corrected claims or appeals as needed. Research and respond to payer inquiries regarding claim status and payment discrepancies. Post payments, adjustments, and denials to patient accounts and reconcile with remittance advices. Maintain accurate billing and claims documentation to support audits and compliance checks. Communicate with patients to explain insurance coverage, balances, and payment responsibilities. Collaborate with clinical and administrative teams to ensure proper coding and clean claim submission. Escalate unresolved claims and payment delays to management for further review. Maintain strict confidentiality and adhere to HIPAA regulations. Stay up to date on insurance payer policies, reimbursement changes, and industry regulations.

Job Type:

Full-time Pay:

$24.00 - $28.00 per hour

Benefits:

401(k) 401(k) 4% Match 401(k) matching Health insurance Paid time off Vision insurance People with a criminal record are encouraged to apply

Experience:

insurance claims: 1 year (Preferred) ICD-10: 1 year (Preferred) Medical billing: 1 year (Preferred) Ability to

Commute:

Costa Mesa, CA 92626 (Preferred)

Work Location:

In person