Healthcare Claims Support - Provider-Facing

Innovative Integrated Health; Fresno (CA); On-site; USD 38,000 - 60,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Employee assistance program

Employee discount

Flexible spending account

Health insurance

Health savings account

Life insurance

Paid sick time

Paid time off

Referral program

Retirement plan

Vision insurance

Job summary

Innovative Integrated Health in the Fresno, CA area is seeking a Claims Customer Service Representative (CCSR) to serve as a critical liaison between the company and external providers. The CCSR handles inquiries about medical and dental claims, researches status, denials, and payment discrepancies, and documents interactions accurately.

The ideal candidate has at least two years’ experience, knowledge of ICD-10, CPT, HCPCS, and HIPAA regulations, strong communication skills, and the ability to

Qualifications

• Proficient in Microsoft Office; familiarity with claims processing software.
• Familiarity with medical billing terminology (ICD-10, CPT, HCPCS) and Explanation of Payments (EOPs).
• Strong oral and written communication skills.
• Ability to multi-task and remain detail-oriented under pressure.
• Knowledge of HIPAA regulations and privacy standards.

Responsibilities

• Respond to Provider inquiries regarding medical and dental claims via phone and email.
• Research and resolve issues related to claims status, denials, and payment discrepancies.
• Maintain up-to-date knowledge of benefit plans, claim adjudication guidelines, coding requirements, and HIPAA regulations.
• Accurately document all interactions and claim actions in the Company system by compliance standards.
• Maintain accurate records of interactions and claim resolutions.
• Communicate complex benefit details in a clear and concise manner to Providers.
• Collaborate with internal departments to facilitate resolution of claims-related issues.
• Recommend process improvements to enhance service delivery and improve Provider experience.

Skills

Microsoft Office

Claims processing

Communication skills

Multi-tasking

HIPAA compliance

Education

High School Diploma or GED

Tools

Claims processing software

ICD-10 terminology

CPT & HCPCS coding

Job description

Innovative Integrated Health in the Fresno, CA area is seeking a Claims Customer Service Representative (CCSR) to serve as a critical liaison between the company and external providers. The CCSR handles inquiries about medical and dental claims, researches status, denials, and payment discrepancies, and documents interactions accurately.

The ideal candidate has at least two years’ experience, knowledge of ICD-10, CPT, HCPCS, and HIPAA regulations, strong communication skills, and the ability to