Medical Claims Specialist — PTO & 401(k) Match

Premier Health Group; Irvine (CA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

401(k) Matching

PTO

Job summary

Premier Health Group is seeking a dedicated Medical Claims Specialist to manage the claim follow-up process, ensure accurate and timely payments, and support patients and payers. You will review denials, submit appeals, and coordinate with internal teams to resolve discrepancies.

The role requires 2+ years in medical billing/coding, knowledge of ICD-10 and CPT coding, and strong communication skills. A fast-paced environment with attention to detail is essential.

Qualifications

• High school diploma or equivalent (required); Associate's degree in healthcare administration or related field (preferred)
• Minimum of 2 years of experience in medical billing and coding
• Minimum of 2 years of experience in correspondence and medical claim denials
• Strong understanding of medical billing regulations and procedures, including ICD-10, CPT coding, and healthcare insurance guidelines
• Excellent communication skills, both verbal and written
• Strong attention to detail and ability to work in a fast-paced environment
• Proficiency in medical billing software and general office software (e.g., Microsoft Office)

Responsibilities

• Review payment rejections and denials to ensure accurate processing
• Develop and submit appeals to insurance companies to maximize reimbursement
• Manage requests for medical records from payers promptly and accurately
• Collaborate with patients, payers, and internal teams to resolve billing discrepancies
• Post payments to claims in the billing system accurately
• Inform patients about billing details and assist with payment obligations
• Maintain up-to-date financial records for each patient account

Skills

Communication skills

Attention to detail

Experience in medical billing

Knowledge of ICD-10/CPT

Regulatory compliance

Education

Associate's degree in healthcare administration or related field

High School diploma or equivalent

Tools

Billing software

Microsoft Office

Electronic Health Records (EHR) systems

Job description

Premier Health Group is seeking a dedicated Medical Claims Specialist to manage the claim follow-up process, ensure accurate and timely payments, and support patients and payers. You will review denials, submit appeals, and coordinate with internal teams to resolve discrepancies.

The role requires 2+ years in medical billing/coding, knowledge of ICD-10 and CPT coding, and strong communication skills. A fast-paced environment with attention to detail is essential.