Position Title: Medical Claims Recovery Specialist
Location: Office Environment, El Monte, CA (onsite)
Employment Type: Full-Time
Key Responsibilities:
Quality and Production Standards: Ensure that departmental quality and production goals are met consistently during regular work hours.
Claims Processing and Denial Management: Review eligibility and retroactive eligibility monthly to process claims accurately. Analyze each invoice's denials, rebill as necessary, and document amounts for write-offs in a timely manner.
Document Management: Create, update, and monitor policies, procedures, desktop protocols, workflow documents, and job aids to ensure current standards.
Invoice Review and Communication: Update monthly invoices and alert management of any issues requiring additional attention.
Issue Resolution: Follow up on identified issues to ensure timely resolution and coordinate with internal departments on claims processing improvements.
Metrics Tracking and Reporting: Track and analyze metrics related to claims adjudication and denial processes. Prepare written and verbal reports for management.
Denial Analysis and Root Cause Identification: Research concentrated denial reasons within the department and recommend corrective actions for recurring issues.
Process Improvement Recommendations: Proactively suggest process and system enhancements to improve department efficiency.
Special Projects and Reporting: Complete assigned projects and generate reports within established time frames.
System Enhancements Testing: Assist in testing, modifying, and analyzing system enhancements related to claims processing.
Other Duties: Perform any additional tasks assigned by management.
Minimum Qualifications:
Education: High school diploma or GED required.
Minimum of 3+ years of claims/invoices processing experience, preferably in a medical facility claims environment.
3-5 years as a claims examiner handling Provider Dispute Resolutions (PDRs).
Strong ability to multitask in a high-production environment.
Proficient in Microsoft Word and Excel.
Ability to analyze data and draw actionable insights for management.
Excellent written and verbal communication skills for collaboration with a diverse team.
Ability to research and resolve complex claims issues.
Successful completion of a criminal background check.
Compliance with government exclusion lists at hire and on a monthly basis.
Basic PC skills and the ability to type at least 40 wpm.
All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.
