What are the responsibilities and job description for the Medical Biller position at Spark Sleep Solutions?
Prior Authorizations & Medical Claims Follow-up Specialist
Job Title: Prior Authorizations & Medical Claims Follow-up Specialist
Location: San Jose, CA- hybrid role is possible
Job Type: Full Time
Reports To: Billing Operations Manager
Job Summary:
We are seeking a detail-oriented and organized Prior Authorizations & Medical Claims Follow-up Specialist to manage the authorization process and ensure timely reimbursement of medical claims. This role involves obtaining prior authorizations, following up on insurance claims, and resolving denials or payment issues to optimize revenue cycle performance. Experience with DME billing is a plus!
Company Overview:
We are seeking a friendly, energetic professional who enjoys interacting with patients and thrives in a fast-paced, collaborative environment. If you're looking for a stable, long-term career with opportunities for growth and development, we encourage you to apply. We value employee dedication and offer comprehensive training to ensure your success.
Key Responsibilities:
Prior Authorizations:
If you possess a passion for patient care, exceptional interpersonal skills, and a desire to contribute to our thriving practice, we encourage you to submit your resume and cover letter detailing your relevant experience and qualifications. We eagerly await your application!
Equal Opportunity Employer:
We are committed to fostering a diverse and inclusive workplace and welcome applications from all qualified individuals without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
E-Verify Notice:
Spark Sleep Solutions participates in the E-Verify program, a federal verification system that helps employers verify the identity and employment eligibility of newly hired employees. As part of our commitment to maintaining a legal and compliant workforce, we utilize E-Verify for all new hires.
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Job Title: Prior Authorizations & Medical Claims Follow-up Specialist
Location: San Jose, CA- hybrid role is possible
Job Type: Full Time
Reports To: Billing Operations Manager
Job Summary:
We are seeking a detail-oriented and organized Prior Authorizations & Medical Claims Follow-up Specialist to manage the authorization process and ensure timely reimbursement of medical claims. This role involves obtaining prior authorizations, following up on insurance claims, and resolving denials or payment issues to optimize revenue cycle performance. Experience with DME billing is a plus!
Company Overview:
We are seeking a friendly, energetic professional who enjoys interacting with patients and thrives in a fast-paced, collaborative environment. If you're looking for a stable, long-term career with opportunities for growth and development, we encourage you to apply. We value employee dedication and offer comprehensive training to ensure your success.
Key Responsibilities:
Prior Authorizations:
- Submit prior authorization requests to insurance providers for medical procedures, medications, and treatments
- Track and follow up on pending authorizations, ensuring timely approvals to prevent treatment delays
- Communicate with healthcare providers and insurance representatives to resolve authorization-related issues
- Maintain accurate records of authorization approvals, denials, and appeal processes
- Monitor and track outstanding insurance claims to ensure timely processing and reimbursement
- Investigate claim denials or underpayments and initiate appeals when necessary
- Communicate with insurance companies, patients, and providers to resolve billing discrepancies
- Update patient records and billing systems with claim status and payment details
- Stay updated on insurance policies, coding changes, and payer requirements to minimize claim rejections
- Experience in prior authorizations, medical billing, or insurance claims processing
- Strong knowledge of medical insurance policies, claim adjudication, and reimbursement processes
- Familiarity with CPT, ICD-10, and HCPCS coding
- Familiarity with navigating all portal logins: Availity, Blue Shield, Cigna, Healthnet, UMR
- EXTREMELY detail- oriented, strong self starter, strong problem solving skills, eager to learn and adapt to new challenges
- Proficiency in electronic health records (EHR) and medical billing software
- Excellent communication
- Strong attention to detail and ability to manage multiple tasks effectively
- Always up for a challenge and ready to learn!
- High school diploma or equivalent (required); Associate’s or Bachelor’s degree in healthcare administration, medical billing, or a related field (preferred)
- 5 years of experience in prior authorizations, medical billing, or healthcare claims follow-up
- Certification in medical billing/coding (e.g., CPC, CPB) is a plus
- Experience with DME claims is a plus!
- In-office, possibly hybrid
- M-F, standard hours
- Competitive Salary: We offer a competitive salary based on your experience and qualifications
- Performance Rewards: Your hard work and dedication will be recognized through performance incentives, bonuses, and opportunities for raises
- Comprehensive Benefits Package: Enjoy a full range of benefits, including medical, dental, vision insurance, paid time off (PTO), sick leave, and a 401k retirement plan
- Travel Reimbursement: We provide transportation and travel compensation for local trips to our satellite offices
- No Weekends: This full-time position offers a balanced schedule with no weekend work
If you possess a passion for patient care, exceptional interpersonal skills, and a desire to contribute to our thriving practice, we encourage you to submit your resume and cover letter detailing your relevant experience and qualifications. We eagerly await your application!
Equal Opportunity Employer:
We are committed to fostering a diverse and inclusive workplace and welcome applications from all qualified individuals without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
E-Verify Notice:
Spark Sleep Solutions participates in the E-Verify program, a federal verification system that helps employers verify the identity and employment eligibility of newly hired employees. As part of our commitment to maintaining a legal and compliant workforce, we utilize E-Verify for all new hires.
Powered by JazzHR
kfGUtTIVR3