Healthcare Claims Specialist — Denials & Appeals

Shield HealthCare; Washington (IL); On-site; USD 22,000 - 32,000; Full time

Benefits offered by this job

Medical, Dental, and Vision (Available

401(k) with Company Match

Sick and Vacation Days

Flexible Spending Account

Life & Disability Insurance

Education Assistance

Job summary

Shield HealthCare is seeking a Healthcare Claims Associate to research claim denials and underpayments, performing necessary corrections to meet billing guidelines or recommend write-offs.

This is an on-site role in Valencia, CA, with responsibilities ranging from reviewing billing processes to communicating with third-party payers and updating AR systems. Strong problem solving and Excel skills are essential.

Qualifications

• High school diploma or equivalent.
• 2 years in medical billing or collections.
• Proficiency with Microsoft 365 (Excel, Outlook, PowerPoint, Word, SharePoint, Teams).
• Medical billing/coding certification preferred.
• Familiarity with payer guidelines and billing requirements.
• Experience with Excel.

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 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

Skills

Medical billing

Excel

Communication

Problem solving

Microsoft 365

Attention to detail

Education

High school diploma

Medical billing/coding certification

Tools

MS Office

Job description

Shield HealthCare is seeking a Healthcare Claims Associate to research claim denials and underpayments, performing necessary corrections to meet billing guidelines or recommend write-offs.

This is an on-site role in Valencia, CA, with responsibilities ranging from reviewing billing processes to communicating with third-party payers and updating AR systems. Strong problem solving and Excel skills are essential.