LompocRecruiter Since 2001
the smart solution for Lompoc jobs

Medical Claims Denial Specialist

Company: Lags Spine and Sportcare Medical Centers Inc
Location: Lompoc
Posted on: May 22, 2020

Job Description:

Lags Medical Centers is a multidisciplinary group with 40+ locations in five states. Since 2000, the LAGS alternative approach to pain treatments has returned patients to a healthy, active lifestyle: restoring function by minimizing pain. Lags Medical Centers has a great opportunity for a Medical Claims Denial Specialist. We are looking for an individual with a great attitude and desire to take your career to the next level.Under the supervision of the Manager, the performs advanced level work related to claims denial or underpayment management. The individual is responsible for managing claim denials by conducting a comprehensive review of insurance ERA/EOB denial CAS and Remark Codes, clinical documentation, medical necessity guidelines, eligibility and authorization, ICD-10 Coding, CPT and HCPCS Coding. The Claims Denial Specialist will, based on their analysis, follow each payer specific guidelines for resubmitting corrected claims, filing first level provider dispute resolutions, first level appeals, or other appropriate rework of the claims reviewed. Core Responsibilities:

  • Research payer denials related to referrals, prior authorization, medical necessity, case management, non-covered services, and other billing issues and delays in payment.
  • Initiate appeals with payers appropriately
  • Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medi-Cal, Medicaid, and other Payer policies and procedures
  • Communicate with Manager/Supervisor when Peer-to-Peer reviews may be requested or require and communicate thoroughly and accurately with payers and Peer Review organizations to resolve denials
  • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
  • Make recommendations for additions/revisions/deletions to claim edits to improve efficiency and reduce denials
  • Review payer communications, identifying risk for loss of reimbursement related to medical policies and prior authorization requirements; escalates potential issues to Manager/Supervisor as appropriate
  • Assist with complex, specialized billing and follow-up workflows including but not limited to:
  • ASC, OR and Clinic Procedure billing and reconciliation
  • RAC correspondence and appeal processing, as well as other audit reviews
  • Advanced or Specialized procedures or services requiring extensive communication with other departments
  • Other special projects as assigned We offer a comprehensive benefit package that includes medical, dental, vision, 401k, 11 paid holidays, PTO plan, opportunities for career growth and much more! Join a team of talented professionals at Lags Medical, Apply today..

    Our Medical Claims Denial Specialist needs the following:
    • High school degree or equivalent
    • Minimum of 2 years Medical Billing or related experience required
    • Must be familiar with authorizations, ICD-10 Coding, CPT and HCPCS Coding
    • Must have high attention to detail PI120345618

Keywords: Lags Spine and Sportcare Medical Centers Inc, Lompoc , Medical Claims Denial Specialist, Healthcare , Lompoc, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Healthcare Jobs

Travel Nurse RN - Rehabilitation
Description: Ardor Health Solutions is seeking a travel nurse RN Rehabilitation for a travel nursing job in Bakersfield, California: br br br ul br li Specialty: Rehabilitation br li Discipline: RN (more...)
Company: NurseFly
Location: Bakersfield
Posted on: 06/1/2020

Registered Nurse - FT / Santa Barbara
Description: PRIMARY PURPOSE: Under direct supervision, this position is responsible for performing all duties related to the efficient, safe, and compliant collection of blood and blood products. Works collaboratively (more...)
Company: Vitalant
Location: Santa Barbara
Posted on: 06/2/2020

Physical Med, Rehab & Pain Opening in Bakersfield, CA- Great Benefits
Description: Seeking Board Eligible or Board-Certified Physiatrist to join our Physiatry owned and operated company. Physician will serve as an acute-level pain management/rehab consultant to well-managed, sub-acute (more...)
Company: Britt Medical Search
Location: Bakersfield
Posted on: 06/1/2020

CRNA / Anesthesiology / California / Locum or Permanent / Certified Re
Description: Job Description Requirements br Certified Registered Nurse Anesthetist CRNA - br StartDate: ASAP Available Shifts: Regular 8 10 12 On Call Pay Rate: .00 br br We are currently seeking a Certified (more...)
Company: Locum Leaders..
Location: Bakersfield
Posted on: 06/1/2020

Permanent Pediatrics Physician in Bakersfield, California
Company: Clinica Sierra Vista
Location: Bakersfield
Posted on: 06/2/2020

Class A Reefer Drivers - Now Hiring - 100% Paid Medical
Description: br br br Class A Drivers br br Apply Below or Call 855 978-8825 x 245 and drive off to a great new future br br Certified Freight Logistics has hauled refrigerated products on the West (more...)
Company: CFL - Certified Freight Logistics
Location: Santa Maria
Posted on: 06/2/2020

Family Practice Physician
Description: Looking for a rewarding career as a Physician Come join a dynamic team of Primary Care Doctors at a well known rural hospital just outside Bakersfield, CA. The clinicians we are seeking are those who (more...)
Company: Clinical Nurse Specialist
Location: Santa Maria
Posted on: 06/2/2020

Certified Nursing Assistant
Description: Covenant Care encompasses three business lines that are an integral part of a patients continuum of care and work together to achieve excellence in patient care across California and Nevada: Skilled
Company: Covenant Care
Location: Santa Barbara
Posted on: 06/1/2020

Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN)
Description: Overview It makes me feel good knowing that we make the residents' lives better. We laugh with them, cry with them, sing and dance with them - we brighten their day. Working here is an unbelievable privilege (more...)
Company: Sunrise Senior Living
Location: Simi Valley
Posted on: 06/1/2020

Physician Assistant - ENT (Physician Assistant #)
Description: Growing ENT practice located in Bakersfield, CA is looking to add a physician assistant or nurse practitioner
Company: Lyle Staffing
Location: Bakersfield
Posted on: 06/1/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Lompoc RSS job feeds