Medicaid Denials & Reimbursement Specialist

LCMC Health; Irvine (CA); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Deliver healthcare with heart

Give people a smile

Put love in your work

Honest with compassion

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Job summary

LCMC Health seeks a detail-oriented follow-up and denial management professional in the Irvine area. You will handle daily follow-up or denial account assignments, identify underpayments and discrepancies, and process denials and appeals with third-party payers to secure timely reimbursement.

You will review payments and EOBs, document activities on patient accounts, and collaborate across departments to ensure accurate reimbursements while adhering to HIPAA and regulatory guidelines.

Qualifications

• High school diploma or GED; healthcare billing/denial experience preferred.

Responsibilities

• Maintain responsibility for accurate and timely completion of daily follow-up or denial account assignment.
• Identify and analyze underpayments to identify reasons for discrepancies and process denials and appeals as needed.
• Review posted payments and adjustments to ensure accuracy.
• Analyze EOBs to ensure proper reimbursement.
• Conduct relevant research to complete the appeals process to include assessing, complete and accurate documentation, tracking, responding to, and / or resolving appeals with third party payers in a timely manner.
• Communicate with payers on outstanding claims, resolve payment variances and achieve timely reimbursement.
• Document all activity on the patient account.
• Collaborate with internal departments and external organizations to ensure correct reimbursement and resolve appeals.
• Monitor underpaid and denied claims for trends and identify root causes and reports findings to supervisor.
• Observe best practice processes in follow-up and customer service activities.
• Participate in staff training that aligns with recognized improvement opportunities and increases understanding of Medicare/Medicaid requirements as well as general follow-up processes.
• Act in accordance with LCMC Health's mission and values, while serving as a role model for ethical behavior.
• Adhere to federal and state regulations related to the protection of patient information (HIPAA) as well as facility-specific guidelines.

Education

High school diploma or GED

Job description

LCMC Health seeks a detail-oriented follow-up and denial management professional in the Irvine area. You will handle daily follow-up or denial account assignments, identify underpayments and discrepancies, and process denials and appeals with third-party payers to secure timely reimbursement.

You will review payments and EOBs, document activities on patient accounts, and collaborate across departments to ensure accurate reimbursements while adhering to HIPAA and regulatory guidelines.