Medicaid Eligibility Claims Specialist in Santa Ana, CA at Parallon

Date Posted: 9/3/2018

Job Snapshot

Job Description

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Position Summary:


This position is responsible for investigating, researching, and facilitating of unpaid claims from various out of state Medicaid agencies.


  • Claims posting of data from UB04 or 1500 into HCLS3 system
  • Verify information obtained from patients and medical providers regarding insurance coverage with insurance companies for accuracy at the time of service
  • Enters appropriate notes and takes appropriate actions in the system to route claims to appropriate departments for processing.
  • Obtain bills and medical records from medical providers and send them to insurance companies for processing, in compliance with HIPAA and FDCPA standards.
  • Follows up with payers, vendors and clearinghouse on open insurance claims and balances.
  • Perform aggressive follow-up on unresolved claims and facilitates payment from appropriate payers.
  • Follow up with clients and insurers to resolve issues and discuss reasons for reduced or unpaid claims.
  • Maintain and update proper account documentation.
  • Meet productivity and quality benchmarks as set by the department.
  • Escalates claim issues to Manager, or department based on the nature of the issue.
  • Responds to incoming inquiries, complaints and appeals and resolves issues for clients.
  • Maintains and protects confidentiality with regard to all aspects of patient care information.
  • Other tasks and projects as assigned.

Job Requirements

Training and Experience:


  • Working knowledge of ICD9, CPT codes, HIPAA, HCPCS and Medicaid preferred
  • 1-3 years of related experience in the field or in a related area
  • Excellent verbal and written communication skills,
  • Critical thinking and strong attention to detail.
  • Ability to multi task and prioritize.
  • Experience using MS Word and Excel, and Outlook


The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhaustive list of responsibilities, duties and skills required.