HCA, Hospital Corporation of America Claims Specialist in Santa Ana, California

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.

    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

Title: Claims Specialist

Location: California-Santa Ana-Santa Ana (SAN) - RCPS

Requisition ID: 26576-125542