A Claims Representative accepts and reviews applications for insurance and provides information to insurance agents. Assists insurance customers, answers questions and processes requests to change or cancel policies. May assist with insurance claims that are disputed, review claims and policy coverage and help to negotiate agreements between customers and an insurance company.
Full-Time, In-Person About Lifedoc Health Lifedoc Health is more than just a clinic — we are a movement dedicated to empowering our community through accessible, patient-centered care, education, and groundbreaking research. We serve diverse populations with a focus on lasting wellness, not just treating symptoms. Come be part of something bigger!
Job Summary:
The Bilingual Revenue Cycle and Membership (BRCMS) plays a critical role in maximizing revenue by handling insurance claims, patient collections, payment posting, and accounts receivable follow-up. This position is responsible for improving cash flow and reducing aging accounts receivable, while ensuring compliance with all applicable healthcare regulations. The BRCMS will help to remove the economic barriers the underprivileged population faces when trying to treat their acute or chronic diseases. The role will oversee sales, retention, education and communication of the Vida Plus program. What You'll Do Proactively contact patients and insurance companies to collect overdue medical balances and resolve unpaid claims. Follow up on commercial, HMO, PPO, Medicare, Medicaid, Vida Plus, and Vida Plus Premier claims until resolution. Review and verify insurance eligibility and benefits as necessary while resolving unpaid claims. Submit, monitor, and follow up on insurance claims to ensure timely reimbursement. Investigate and resolve denied, rejected, and underpaid claims. Prepare and submit claim reconsiderations, corrected claims, and formal appeals as needed. Track unpaid claims and communicate with insurance carriers and patients regarding outstanding balances. Monitor post-billing accounts and identify delinquent patient balances requiring follow-up. Contact patients and responsible parties to facilitate prompt payment of outstanding balances. Post patient and insurance payments (ERA/EOB) timely and accurately and reconcile payment discrepancies. Negotiate payment arrangements in accordance with organizational policies and document agreements accurately Promote and expand the Vida Plus program by engaging with businesses and negotiating contracts. Develop and implement strategies to increase program adoption and satisfaction. Manage and maintain relationships with current and potential Vida Plus clients. Support the Vida Plus program by managing day-to-day operations and keeping up with the claims associated with Vida Plus Ensure the membership payments are processed daily and that the appropriate collection process is followed to prevent outstanding balances Update the EMR and post adjustments as needed Assist in any financial reporting, data entry, and reconciliation projects as needed. What We're Looking For High school diploma or GED required ; associates degree or equivalent technical training preferred Minimum of 3 years of medical billing, collections, or revenue cycle experience Bilingual in (Spanish / English) and proficiency in reading, writing and speaking in both languages is required Ability to work independently while contributing to a team environment and work as an effective team member when needed. Proficiency in Microsoft Office, including Excel, Outlook, and Word. Working knowledge of Medicare, Medicaid, commercial insurance plans, HMO/PPO products, and managed care reimbursement. Experience with medical claims processing, payment posting, insurance follow-up, and patient collections. Knowledge of CPT, ICD-10-CM, and HCPCS coding concepts. Strong understanding of Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA). Proficiency with Electronic Medical Record (EMR) and Practice Management systems. Strong analytical and problem-solving skills. Ability to be flexible and adaptable to change. Excellent customer service and conflict-resolution skills. Excellent written and verbal communication skills. Strong organizational skills with exceptional attention to detail. Ability to prioritize multiple tasks while meeting deadlines. Must have current active driver's license and be able to drive to different locations when needed. Must be persuasive and resilient regarding the product offerings Ability to work in a high-paced and at times stressful environment Why Lifedoc Health? At Lifedoc, you're not just joining a workplace — you're joining a mission. Here, your work directly transforms lives and helps reshape the future of healthcare. We invest in your professional growth while supporting your passion for community impact. If you're ready to lead with purpose and heart, apply today and become part of the Lifedoc Health team!
Benefits:
401(k) matching Dental insurance Employee assistance program Health insurance Health savings account Life insurance Paid time off Referral program Vision insurance
