Healthcare Claims Specialist – Denials & Underpayments

Shield California Health; Morgan Hill (CA); Presencial; USD 22.000 - 32.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental, Vision

401(k) with company match

Sick and Vacation Days

Flexible Spending Account

Life & Disability Insurance

Education Assistance

Descripción de la vacante

Shield HealthCare in Valencia, CA is seeking a Healthcare Claims Associate to research claim denials, underpayments, and corrections to meet billing guidelines. This on-site role requires attention to detail and strong communication with payers and internal staff.

Qualifications include a high school diploma, 2 years in medical billing, and proficiency with Microsoft 365 and Excel. Benefits include health, 401(k), and paid time off.

Formación

• High school diploma or equivalent is required.
• 2 years in medical billing or collections or similar experience.
• Microsoft 365 proficiency; Excel experience preferred.
• Medical billing/coding certification is a plus.
• Familiarity with payer guidelines and billing requirements.

Responsabilidades

• Review claims processes to improve financial outcomes.
• Research denials, underpayments, and write-offs when appropriate.
• Inform management of trends in billing issues and guidelines.
• Adjudicate issues by submitting corrected claims and appeals.
• Communicate with third-party payers and staff to resolve issues.
• Keep AR system notes updated and accurate.

Conocimientos

Strong communication

Research & problem solving

Organizational skills

Excel usage

Educación

High school diploma or equivalent

Medical billing/coding certification (preferred)

Herramientas

Microsoft 365

Excel

Descripción del empleo

Shield HealthCare in Valencia, CA is seeking a Healthcare Claims Associate to research claim denials, underpayments, and corrections to meet billing guidelines. This on-site role requires attention to detail and strong communication with payers and internal staff.

Qualifications include a high school diploma, 2 years in medical billing, and proficiency with Microsoft 365 and Excel. Benefits include health, 401(k), and paid time off.