Healthcare Claims Associate- Onsite

Shield Healthcare; California; On-site; USD 22,000 - 32,000; Full time

Benefits offered by this job

Medical, Dental, and Vision

401(k) with Company Match

Sick and Vacation Days

Flexible Spending Account

Life & Disability Insurance

Education Assistance

Job summary

Shield Healthcare in Valencia, CA is seeking a Healthcare Claims Associate to research claim denials and underpayments, and to prepare corrected claims and appeals. This on-site role focuses on accurate billing and timely resolutions.

The ideal candidate will have a high school diploma and 2 years in medical billing or collections, plus strong communication and Microsoft 365 proficiency. Benefits include healthcare and retirement plans.

Qualifications

• High school diploma or equivalent completed.
• 2 years in medical billing or collections or related role.
• Proficiency with Microsoft 365 and common office tools.
• Familiarity with payer guidelines and billing requirements.
• Strong written and verbal communication; detail oriented.

Responsibilities

• Review claims billing processes to improve financial outcomes.
• Identify issues causing denials, rejections, and underpayments.
• Inform management of billing trends and payer guidelines.
• Research denials using EOBs, manuals, portals, and calls.
• Prepare corrected claims and appeals for submission.
• Suggest write-offs when billing requirements are not met.
• Communicate with payers and staff to resolve issues.
• Update accounts receivable and follow up as needed.
• Stay current with company policies and third-party guidelines.
• Complete special projects supporting team goals.

Skills

Research skills

Communication

Organization

Problem solving

Education

High school diploma or equivalent

Medical billing/coding certification (preferred)

Tools

Microsoft 365 Suite

Excel

Outlook

SharePoint/Teams

Job description

Since 1957, Shield Healthcare has provided high-quality healthcare services while focusing on customer satisfaction and employee achievement. We are dedicated to fulfilling the medical supply needs of consumers and the caregiving community while maintaining a 99% overall customer satisfaction rating. Over the years, Shield HealthCare has expanded nationally with current service locations in California, Colorado, Illinois, Ohio, Texas and Washington.

Shield HealthCare is looking for a Healthcare Claims Associate to research claim denials and underpayments, completing necessary corrections to meet various required billing guidelines or provide recommendation of claims write-offs.

This is an on-site position in Valencia, CA.

JOB RESPONSIBILITIES:

• Reviews the claims billing processes, looking for ways to achieve positive financial outcomes
• Identify problems and find solutions to claim rejections, denials, and underpayments
• Inform management of trends in billing issues related to internal processes, clearinghouse claims processing, and third-party requirements
• Research denials and billing requirements of third-party carriers utilizing EOBs, provider manuals, web portals, and phone contact
• Adjudicate claims issues by preparing and submitting corrected claims and appeals
• Recommend claims for write-off when billing requirements are not met
• Effectively communicate by phone, email, and in-person with third-party payers and internal staff to resolve billing issues and establish positive relationships
• Accurately update and notate accounts receivable system, collections notepad, and customer accounts
• Remain updated on company policies and procedures and third-party payer guidelines, bulletins, and billing requirements
• Ensure appropriate follow-up and timely completion of assignments
• Completes special projects as assigned, supporting team and organizational objectives and continuous improvement initiatives

QUALIFICATIONS:

• High school diploma or equivalent
• 2 years in a medical billing or collections role or similar experience
• Proficiency in Microsoft 365 (Excel, Outlook, PowerPoint, Word, SharePoint, Teams) and other standard productivity tools.
• Medical billing and coding certification from accredited program preferred
• Familiarity with various medical insurance payer guidelines/billing requirements preferred
• Experience working in Excel
• Strong written and verbal communication abilities
• Proven ability to research and solve problems
• Strong organizational skills, detail oriented, thorough, accurate, with the ability to manage multiple priorities and respond to changing business needs

PAY & BENEFITS:

• $19.50/hour
• Medical, Dental, and Vision ( Available first day of employment)
• 401(k) with Company Match
• Sick and Vacation Days
• Flexible Spending Account
• Life & Disability Insurance
• Education Assistance

PHYSICAL REQUIREMENTS:

• This is primarily an office-based role with 0% of required travel.
• While performing the duties of this job, the employee is regularly required to sit, use a computer, keyboard, mouse, phone, and standard office equipment, and communicate verbally and in writing.
• The employee is frequently required to use hands and fingers to handle documents, operate office equipment, type, file, copy, scan, and perform other administrative tasks.
• The employee is occasionally required to stand, walk, bend, reach, stoop, or move within the office.
• The employee may occasionally lift, carry, push, or pull office supplies, files, meeting materials, or packages weighing up to 25 pounds.
• Specific vision abilities required for this role include close vision and the ability to view a computer screen, read documents, review data, and prepare written materials for extended periods.
• Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions of the job.

Career-minded individuals will find our business challenging and our reputation for excellence just one of the rewards we have to offer. To further enhance this tradition of excellence, our employees participate in continuous training and development programs in a variety of disciplines.

The posted range for this position is 19.50 per hour which is the expected starting base salary range for an employee who is new to the role to fully proficient in the role. Many factors go into determining employee pay withing the posted range including education, prior experience, training, current skills, certifications, location/labor market, internal equity, etc.

Shield Healthcare, Inc. is an Equal Employment Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, creed, national origin, ancestry, disability that can be reasonably accommodated without undue hardship, sex, sexual orientation, gender identity, age, citizenship, marital or veteran status, or any other legally protected status.

Monday-Friday 8am-4:30pm