Payment Posting & Denials Specialist

Titanium Healthcare • Garden Grove, CA

3d • Hybrid

About The Position

The Payment Posting & Denials Specialist is responsible for the accurate and timely posting of health plan payments, reconciliation of remittance information, and resolution of claim denials for Enhanced Care Management (ECM), Community Supports (CS), and Outreach services. This role works closely with billing, operations, and payer representatives to ensure accurate reimbursement from Medi-Cal managed care plans. The ideal candidate will have strong payment posting experience, an understanding of Medi-Cal and managed care reimbursement, and the ability to research and resolve claims-related issues to maximize revenue recovery.

Requirements

• Knowledge of payment posting, remittance processing, claim adjudication, denial management, and reimbursement methodologies
• Strong analytical and problem-solving skills with the ability to identify payment trends and reimbursement issues
• Excellent attention to detail and organizational skills
• Fluent in English (written and verbal)
• Ability to communicate clearly in-person, by phone, and electronically
• Adequate hearing and vision (with corrective devices if necessary) to conduct assessments and documentation
• Ability to identify problems and use logic and related information to develop and implement solutions
• Excellent written, verbal, and interpersonal communication skills with the ability to communicate effectively with employees and leaders at all levels of the organization
• Must be able to remain in a stationary position
• Must be able to move around the office and/or travel throughout community
• Ability to travel as needed to support business operations and organizational initiatives
• Frequent use of computers, keyboard, and handheld/mobile devices
• Ability to type for extended periods
• Competent with computers, email, virtual platforms, and programs
• Proficiency in Microsoft Office Suite, including Excel, with experience using business systems, reporting tools, and data analysis software
• Diploma/GED required
• Minimum 3+ years of healthcare revenue cycle experience with a strong focus on payment posting and accounts receivable follow-up
• Experience reviewing ERAs, EOBs, payment reports, and claim status information
• Distraction-free home workspace with a secure internet connection

Nice To Haves

• Associate or bachelor's degree in healthcare administration, business administration, accounting, or another related field preferred
• Experience working with Medi-Cal managed care plans and government-funded healthcare programs
• Experience using eClinicalWorks (eCW)
• Experience billing, posting payments, and resolving denials for ECM, CS, Outreach, or other Medi-Cal funded programs
• Experience with claim appeals, disputes, and denial prevention strategies

Responsibilities

• Accurately post payments, adjustments, recoupments, and offsets received from health plans and managed care organizations
• Review and reconcile Electronic Remittance Advice (ERA), Explanation of Benefits (EOB), EFT payments, and check payments
• Identify and resolve payment discrepancies, underpayments, overpayments, and unapplied payments
• Research reimbursement issues and coordinate with payers to obtain additional information when needed
• Monitor payer payment trends and escalate recurring reimbursement issues
• Review denied claims and determine appropriate action for resolution
• Submit corrected claims, disputes, reconsiderations, and appeals as appropriate
• Work collaboratively with billing, authorization, and operations teams to resolve claim issues impacting reimbursement
• Track and follow up on outstanding denials and high-dollar balances
• Maintain accurate documentation of payment posting activities, denial resolutions, and account follow-up efforts
• Assist with month-end payment reconciliation and reporting
• Ensure compliance with payer guidelines, company policies, and regulatory requirements
• Support special revenue cycle projects and departmental initiatives as assigned

Benefits

• 12 holidays
• up to 15 days of accrued PTO
• additional time off for sick, jury duty, bereavement, reproductive loss, and therapy
• Medical, Dental, & Vision Benefits
• Unlimited therapy sessions funded 100% by Titanium Healthcare
• Flexible Spending, Health Savings & Dependent Care Accounts
• Life/AD&D insurance funded 100% by Titanium Healthcare
• Supplemental Disability Plans
• Employee Assistance Programs
• Pet Insurance
• Employee Referral Program: earn up to $1000 for each referral
• 401(k) plan and Roth IRA options

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED