CodeMax Behavioral Health Billing
Senior Claims Specialist (Substance Abuse Billing)
CodeMax Behavioral Health Billing, Los Angeles, California, United States, 90079
Senior Claims Specialist (Substance Abuse Billing)
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Reports to: Director of RCM Employment Status: Full-Time Classification: Non-exempt Location: Van Nuys, CA Work Location: On Site Work Hours: 8:00 AM - 4:30 PM, Monday–Friday
Job Summary The Senior Claims Specialist at CodeMax is responsible for ensuring timely and accurate claim submissions, reducing denials, and optimizing reimbursement processes. The specialist will work closely with insurance companies to rectify payment denials, settle disputes, and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims.
Responsibilities
Claims Processing & Accuracy: Ensure timely and accurate claims submission in accordance with payer requirements and industry regulations.
Monitor claims scrubbing processes to minimize rejections and denials.
Follow-up on claims corrections, resubmissions, and appeals for denied claims.
Denials & AR Management: Analyze denial trends and implement strategies to improve claim acceptance rates; collaborate with the Appeals and AR teams to resolve outstanding claims and negotiate underpayments; ensure follow-up on all unpaid claims over 30 days and escalate problematic claims as needed.
Compliance & Quality Assurance: Ensure claims processing aligns with HIPAA, payer guidelines, and regulatory compliance requirements; work closely with coding and clinical documentation teams to prevent claim denials due to documentation errors.
Reporting & Process Improvement: Identify bottlenecks in claims workflows and implement process improvements; collaborate with billing, VOB, and UR teams to optimize revenue cycle efficiency.
Key Performance Indicators Clean Claim Rate: ≥ 95% Denial Rate: ≤ 10% AR Days Outstanding: ≤ 30 days Appeal Success Rate: ≥ 75% Claims Submission Turnaround: ≤ 48 hours post-service
Qualifications & Experience Education:
Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred Equivalent work experience in RCM or medical billing/claims will be considered
Experience:
3-5 years of experience in medical claims processing, billing, or revenue cycle management Strong knowledge of payer guidelines, insurance contracts, and reimbursement models (Medicare, Medicaid, Commercial).
Skills & Competencies
Claims & Denial Management Expertise; analytical and problem-solving skills; communication and negotiation
Technical Proficiency – Experience with RCM software, payer portals and EHR systems
Benefits
Health Insurance
Vision Insurance
Dental Insurance
401(k) plan with matching contributions
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Reports to: Director of RCM Employment Status: Full-Time Classification: Non-exempt Location: Van Nuys, CA Work Location: On Site Work Hours: 8:00 AM - 4:30 PM, Monday–Friday
Job Summary The Senior Claims Specialist at CodeMax is responsible for ensuring timely and accurate claim submissions, reducing denials, and optimizing reimbursement processes. The specialist will work closely with insurance companies to rectify payment denials, settle disputes, and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims.
Responsibilities
Claims Processing & Accuracy: Ensure timely and accurate claims submission in accordance with payer requirements and industry regulations.
Monitor claims scrubbing processes to minimize rejections and denials.
Follow-up on claims corrections, resubmissions, and appeals for denied claims.
Denials & AR Management: Analyze denial trends and implement strategies to improve claim acceptance rates; collaborate with the Appeals and AR teams to resolve outstanding claims and negotiate underpayments; ensure follow-up on all unpaid claims over 30 days and escalate problematic claims as needed.
Compliance & Quality Assurance: Ensure claims processing aligns with HIPAA, payer guidelines, and regulatory compliance requirements; work closely with coding and clinical documentation teams to prevent claim denials due to documentation errors.
Reporting & Process Improvement: Identify bottlenecks in claims workflows and implement process improvements; collaborate with billing, VOB, and UR teams to optimize revenue cycle efficiency.
Key Performance Indicators Clean Claim Rate: ≥ 95% Denial Rate: ≤ 10% AR Days Outstanding: ≤ 30 days Appeal Success Rate: ≥ 75% Claims Submission Turnaround: ≤ 48 hours post-service
Qualifications & Experience Education:
Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred Equivalent work experience in RCM or medical billing/claims will be considered
Experience:
3-5 years of experience in medical claims processing, billing, or revenue cycle management Strong knowledge of payer guidelines, insurance contracts, and reimbursement models (Medicare, Medicaid, Commercial).
Skills & Competencies
Claims & Denial Management Expertise; analytical and problem-solving skills; communication and negotiation
Technical Proficiency – Experience with RCM software, payer portals and EHR systems
Benefits
Health Insurance
Vision Insurance
Dental Insurance
401(k) plan with matching contributions
#J-18808-Ljbffr