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Claims Specialist
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National Healthcare and Housing Advisors, LLC
Santa Ana, CA (In Person)
$54,080 Salary, Full-Time
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Job Description
Claims Specialist National Healthcare and Housing Advisors, LLC Santa Ana, CA Job Details Full-time $26 an hour 1 hour ago Benefits Health insurance Dental insurance Paid time off Vision insurance Qualifications Appeals Teamwork Managed care Spreadsheets HIPAA Medicaid health insurance ICD-10 Attention to detail Computer skills Medicaid Full Job Description Job Summary The Claims Specialist is responsible for managing unpaid and underpaid insurance claims, researching claim status, and ensuring timely reimbursement. This role supports the revenue cycle by resolving billing discrepancies, reducing accounts receivable aging, and escalating complex issues when necessary. The Claims Specialist is detail-oriented, persistent in follow-up, and proficient in using claims systems, payer portals, clearinghouses, and other billing platforms. Key Responsibilities Prepare, review, and submit electronic and paper claims to insurance payors in a timely manner. Verify patient insurance eligibility and authorization requirements prior to claim submission. Monitor claim status through clearinghouse and payor portals; identify and resolve delays. Review aging reports and work assigned accounts to secure payment from insurance payors Contact payors via phone, portals, or clearinghouse to verify claim status and identify payment delays. Research and resolve denied, rejected, or suspended claims by correcting errors and coordinating rebilling when appropriate. Submit appeals with required documentation within timely filing limits. Identify trends causing payment delays and communicate findings to billing leadership. Document all follow-up activities clearly within the billing system and billing spreadsheets. Collaborate with authorization, coding, and charge entry teams to resolve claim discrepancies. Escalate high-dollar, complex, or compliance-related issues to the Claims Specialist or Supervisor. Assist with payment reconciliation by reporting discrepancies between expected and received reimbursement. Maintain compliance with HIPAA, payor guidelines, and organizational policies. Positions Requirements & Qualifications Knowledge of CPT, ICD-10, and HCPCS coding basics preferred. Familiarity with Medi-Cal/Medicaid and managed care payors. Good communication skills, both written and verbal. Strong attention to detail. Demonstrated ability in sucessfully completing tasks. Strong teamwork skills. Effective multitasking and prioritization skills. Strong computer skills, including proficiency with Excel. Must demonstrate integrity, maturity, dependability, a positive attitude and enthusiasm. EEO/ADA Statement NHHA is an equal opportunity organization committed to diversity, equity, and inclusion in all aspects of service and employment. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected status under applicable law. In accordance with the Americans with Disabilities Act (ADA), we provide reasonable accommodations for applicants, employees, and students with disabilities. We encourage individuals from all backgrounds to apply. Disclaimer This job description is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities required for the position. Duties and responsibilities may change at any time with or without notice