Claims SpecialistChoice Healthcare Services • Vacaville, CA, US

Claims Specialist

Choice Healthcare Services • Vacaville, CA, US

3 days ago

Job type

Full-time

Job description

Claims Specialist

Summary : The claim specialist verifies the accuracy of and completeness of patient's account within the dental practice, ensuring compliance with billing standards and identifying potential errors and fraud prior to the claim being billed to the insurance company.

Pay Range : $22.00-$24.00 per hour (Based on experience)

This is a full time Hybrid position, working at our Vacaville office a few days a week and from Home the other days.

Shift : 7 : 00am - 4 : 00pm

CHOICE Healthcare Services is the largest provider of pediatric dental care in the Southwest United States, and we pride ourselves on delivering high quality care to children in our communities. Every day, thousands of people trust us to provide their families with healthy, radiant smiles.

What we provide to you as a CHOICE teammate :

Care for your wellbeing and work-life balance
Professional and personal growth
Experienced leadership support
Fun and supportive team dynamic with events and celebrations
Comprehensive benefit package

Responsibilities

Essential Duties and Responsibilities : include the following. Other duties may be assigned.

Verify insurance coverage and benefits are correct.

Monitor healthcare documents to ensure compliance before submitting to insurance companies

Check medical records for appropriate criteria and provide the proper documentation

Collaborate with providers to ensure all information is accurate

Review requests for services, research and gather further information, when necessary, perform an information audit, and evaluate procedures for approval

Record, analyze, and report data elements that could help improve the quality of care of a patient.

Review treatment plan and chart notes.

Pre-Auditing charts

Post Auditing charts

Respond via teams' chat / email to OPs team & RCM Billing team in a timely manner

Ensure billing errors are flagged and corrected

Create claims

Qualifications

Education and / or Experience and Qualifications :

Associate degree (A.A.) or equivalent from two-year college or technical school; or six months to one year related experience and / or training; or equivalent combination of education and experience, preferred.

Minimum of high school diploma or equivalent.

Experience :

Customer service experience.

Strong MediCal Dental background

Preferred six months previous experience in a health care facility or role to include direct patient contact or previous customer service experience.

Dental healthcare experience in a dental office setting.

Systems- Microsoft Excel, Word, Outlook, Teams, OneNote, Open Dental, NICE, NexHealth

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Claim Specialist • Vacaville, CA, US

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