Medical Claims Specialist

Job Description

Job Description

Bakersfield, CA

$18-22

Summary :

Seeking a detail-oriented professional to drive performance in denial prevention and appeals workflows within a dynamic healthcare environment. This role involves monitoring regulatory updates, supporting claims resubmission efforts, and assisting with special initiatives such as provider training and education to ensure timely reimbursement and process improvement.

Key Responsibilities :

Conduct follow-up on denied claims across multiple commercial and contracted payers, with a focus on resolving issues related to coding discrepancies.

Review and assign ICD-10-CM and CPT-4 codes based on clinical documentation, ensuring accuracy and adherence to compliance standards.

Process claims in accordance with Medicare, AMA, and industry-standard regulatory guidelines.

Analyze patient medical records for precise coding, serving as a key resource to the patient accounts team on coding-related matters.

Investigate claim denials, collaborating with insurance representatives and internal teams to coordinate reprocessing and ensure timely reimbursement.

Perform root-cause analysis on denial trends and contribute to targeted educational efforts based on findings.

Provide ongoing oversight of self-pay accounts, including demographic updates and resolution of routine coding issues.

Participate in continuous improvement initiatives, supporting training needs for provider staff when applicable.

Additional Responsibilities :

HIPAA Compliance : Maintain and enforce strict adherence to all applicable HIPAA privacy and security standards.

Regulatory Compliance : Ensure full compliance with relevant local, state, and federal healthcare regulations.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here :

• 06 / 22- 088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here :

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

https : / / e- verify.uscis.gov / web / media / resourcesContents / E - Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants : Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

#1087

Company Description

This company offers growth and a great group of people to work with.