Top 172 Medical claims Jobs in Riverside, Ca

Denial and Appeals Management Clerk
Riverside-San Bernardino Co. Indian Health, Inc —Grand Terrace, CA
- $22 - $23 an hour
- Weekends as needed
- Hybrid work
- Background check
- BLS Certification
- HIPAA
- Health insurance
- Dental insurance
8d
Insurance Verification Representative - Glenwood Surgical Center
SCA Health —Riverside, CA
- $16.88 - $30.53 an hour
- Full-time
- Surgery
- Bachelor's degree
- Entry level
- Disability insurance
- Health insurance
2d
Xcelys Medical Claims Examiner-REMOTE
NTT DATA —Ontario, CA
- $20 an hour
- Contract
- Remote
- High school diploma or GED
- Analysis skills
- Continuous improvement
Quick Apply
Medical Biller
Raincross Medical Group, Inc. —Riverside, CA
- $19 - $24 an hour
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Paid holidays
- Dental insurance
Quick Apply
Medical Biller
Associated Management Consultants, Inc. —Riverside, CA
- From $20 an hour
- Temporary
- Computer literacy
- Medical office experience
- Basic math
- Paid holidays
- Health insurance
Quick Apply
Medical Billing Specialist
Zymeda Provider Solutions, Inc. —Moreno Valley, CA
- $24 - $28 an hour
- Full-time
- Customer service
- Mid-level
- Office
- Dental insurance
- Vision insurance
Quick Apply
6d
Billing Specialist & Administrative Support
Monte Vista Care Center —Rancho Cucamonga, CA
- $40 an hour
- Full-time
- Google Workspace
- Mid-level
- Office
- Health insurance
- Dental insurance
Quick Apply
PATIENT ACCOUNT REP
Pomona Valley Hospital Medical Center —Pomona, CA
- $23.00 - $30.89 an hour
- 8 hour shift
- Hospital
- High school diploma or GED
- Data entry
Medical Supply Technician Sterile Processing (Technical Career Field Trainee (TCF)
US Veterans Health Administration —Loma Linda, CA
- $67,858 - $88,216 a year
- Online Application
- Background check
- Surgery
- High school
- Dental insurance
9d
Medical Billing Specialist
La sierra medical corp —Riverside, CA
- $18 - $20 an hour
- Full-time
- Customer service
- Medical office experience
- Mid-level
- Paid time off
- Parental leave
Quick Apply
Medical Biller
Symbiosis —Redlands, CA
- From $23 an hour
- Full-time
- Microsoft Word
- Urgent Care
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
8d
Medical Biller- Intermediate Care Facilities (ICF/DDN & DDH)
Monte Vista Childcare Center —Rancho Cucamonga, CA
- $38 - $43 an hour
- Full-time
- Mid-level
- Driver's License
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
Pharmacy Tech
Sam's Club —Riverside, CA
- $22.50 - $30.50 an hour
- High school
- Merchandising
- HIPAA
- Paid jury duty
- Disability insurance
Supervisor, Revenue Cycle
Heritage Health Network —Riverside, CA
- $52,000 - $65,000 a year
- Monday to Friday
- Remote
- Google Workspace
- Mid-level
- Business Administration
- Paid holidays
- Health insurance
Quick Apply
6d
Mailroom Clerk (Entry Level - Training Provided)
Calibrated Healthcare —Ontario, CA
- $17 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
Medical Coding and Billing Specialist
Stallant Health Crescent City —Highland, CA
- $28 - $34 an hour
- Full-time
- Mid-level
- Clinic
- Paid holidays
- Health insurance
Quick Apply
Compliance Coordinator
LSMA Management Inc —San Bernardino, CA
- $28.85 - $33.65 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Mid-level
- Office
Biller/Collector Lead
Confidential —San Bernardino, CA
- $20 - $24 an hour
- Full-time
- Spanish
- Mid-level
- In-person
- Health insurance
- Dental insurance
Quick Apply
9h
Part-time Therapist
Telemynd —California
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Flexible schedule
Quick Apply
Remote Clinical Social Worker (LMFT, LCSW, LPC, LPCC)
Telemynd —California
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Flexible schedule
Quick Apply

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Denial and Appeals Management Clerk

Riverside-San Bernardino Co. Indian Health, Inc -
Grand Terrace, CA

Apply Now

Job Details

Full-time
$22 - $23 an hour
8 days ago

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
Employee discount
Life insurance
Retirement plan

Qualifications

Appeals
Medicare
Commercial insurance knowledge
Managed care organization experience
BLS Certification
Regulatory compliance in claims processing
HIPAA
Medical coding guidelines
High school diploma or GED
Cultural competency
Health information regulatory compliance
Medical explanation of benefits reviews
Medical claims submission
Medical Billing Certification
Clinical confidentiality policies
Insurance claims appeal handling
Medical terminology

Full Job Description

Summary:

Applicant must possess a high school diploma or equivalent. An associate degree in healthcare administration or finance is preferred. Certification as a Certified Professional Biller (CPB) is required. A minimum of two years of experience in healthcare revenue cycle, medical billing, claims processing, collections, and denial management is required. Experience with Medicare, Medi-Cal, Managed Care, and Commercial Insurance payers is required. Experience in an FQHC, Tribal Health, or community health center is preferred. NextGen experience is preferred.Must have knowledge of medical terminology, coding concepts, claim adjudication, EOBs, ERAs, payer portals, denial and appeals management, timely filing limits, and appeal processes. Experience with EHR/practice management systems, NextGen, and clearinghouses such as Waystar is preferred. Must understand healthcare regulations, coding standards, and payer requirements related to claim denials and appeals. Must be able to maintain confidentiality and ensure HIPAA compliance while prioritizing workload and consistently meeting productivity goals. Applicant must have a CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation or within 90 days of employment. The Denials and Appeals Management Clerk is responsible for reviewing, researching, resolving, and appealing denied or underpaid claims to maximize reimbursement and reduce accounts receivable delays. This position works closely with third-party payers, billing, coding, credentialing, providers, and internal departments to ensure timely payment, accurate claim submission, and compliance with applicable regulations. The role also analyzes denial trends, identifies payer issues, supports process improvement, and helps prevent future denials.This position is eligible for a hybrid work schedule. Must be able to work with the Indian Community and be sensitive to the Indian culture and its needs.

Major Duties and Responsibilities:

Review and prioritize high dollar and timely filing-sensitive denied claims from mail, clearinghouses, payer portals, and work queues.
Analyze denied claims, reason codes, and determine appropriate corrective actions.
Identify root causes related to coding, insurance eligibility, referral, authorization, provider documentation, or billing errors.
Correct claims and resubmit within payer filing limits
Monitor aged, denied claims, and maintain denial work queues.
Document all actions and follow-up activities in the practice management system.
Stay current on changes to payer policies, billing regulations, and reimbursement guidelines.
Adhere to patient privacy and confidentiality requirements, including HIPAA regulations.
Prepare and submit first-level and second-level appeals as appropriate.
Gather supporting medical records, referrals, authorizations, and documentation.
Draft appeal letters citing payer policies, medical necessity, coding guidelines, and regulatory requirements.
Track appeal status through payer portals, telephone calls, and payer response deadlines until resolution.
Escalate unresolved claims to management when appropriate or payer representatives.
Coordinate peer-to-peer reviews and reconsideration requests when necessary.
Identify denial trends by payer and denial reason and recurring issues.
Assist in denial prevention education and implement corrective action plans.
Collaborate with coding, billing, patient registration, medical records, and providers to prevent future denials.
Maintain denial logs and appeal tracking spreadsheets.
Support quality assurance and internal audits.
Participate in revenue cycle meetings and payer issue resolution.
Monitor denial rates and appeal outcomes.
Assist in preparing monthly reports that include denial volume, top denial categories, appeal success rates, timely filing issues, and underpayment trends.
This position requires working weekends and evenings, if needed.
Other duties assigned relevant to the position, with relevant training and competency assessment documented.

Qualifications

Education:

High School Diploma or Equivalent required. Associate degree in healthcare administration, or finance preferred.

Certification as a Certified Professional Biller (CPB) is required.

Experience:

A minimum of two years’ experience in healthcare revenue cycle, medical billing, claims processing, collections, and denial management is required. Experience with Medicare, Medi-Cal, Managed Care, and Commercial Insurance payers is required.
Experience in an FQHC, Tribal Health, or community health center is preferred.

Certification:

CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation. Certification may obtained within 90 days of employment.

Knowledge of:

Knowledge of medical terminology, CPT, HCPCS, ICD-10-CM Coding concepts, and claim adjudication. Explanation of benefits (EOBs), Electronic Remittance Advice (ERAs), and payer portals. Denial and Appeals Management Clerk. Familiarity with timely filing limits and appeal processes. Proficiency with Electronic Health Records and Practice Management systems (NextGen Preferred). Experience using clearinghouses such as Waystar is preferred. Knowledge of healthcare regulations, coding standards, and payer requirements relevant to claim denials and appeals.

Skill:

Strong analytical, organizational, and problem-solving skills Excellent verbal and written communication skills Microsoft Office applications. Must understand or be willing to receive Native American cultural competency training and employ cultural awareness with our Native American community.

Ability to:

Demonstrated ability to interpret claim denials, review documentation, and develop effective appeal strategies. Proven ability to investigate denials, identify root causes, and implement corrective actions. Ability to prioritize workload and consistently meet productivity goals. Ability to maintain confidentiality and ensure HIPAA compliance. Must be able to work with the Indian Community and be sensitive to the Indian culture and its needs.

Physical Demands:

This position requires prolonged sitting and computer use, occasional lifting of 20 to 25 pounds, and proficiency with computers, keyboards, and standard office equipment. Dexterity of hands with coordination of eye and hand movement.

Remote Work Eligibility:
This position may be eligible for a hybrid work schedule, eligibility is subject to supervisor approval, position requirements, and organizational needs.

Appointment Type:

Full-Time, Non-Exempt

Compensation:

$22.00–$23.00 per hour ($45,760–$47,840 annually, depending on experience and internal equity)

Clinic Location:

San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313)

Pay: $22.00 - $23.00 per hour

Benefits:

401(k)
Dental insurance
Employee assistance program
Employee discount
Health insurance
Life insurance
Paid time off
Retirement plan
Vision insurance

Work Location: In person

Apply Now

Refine Your Search

medical claims jobs in riverside, ca

Denial and Appeals Management Clerk

Insurance Verification Representative - Glenwood Surgical Center

Xcelys Medical Claims Examiner-REMOTE

Medical Biller

Medical Biller

Medical Billing Specialist

Billing Specialist & Administrative Support

PATIENT ACCOUNT REP

Medical Supply Technician Sterile Processing (Technical Career Field Trainee (TCF)

Medical Billing Specialist

Medical Biller

Medical Biller- Intermediate Care Facilities (ICF/DDN & DDH)

Pharmacy Tech

Supervisor, Revenue Cycle

Mailroom Clerk (Entry Level - Training Provided)

Medical Coding and Billing Specialist

Compliance Coordinator

Biller/Collector Lead

Part-time Therapist

Remote Clinical Social Worker (LMFT, LCSW, LPC, LPCC)

I want to receive the latest job alert for medical claims in riverside, ca

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