Medical Claims Specialist

Qualifications: Bachelor's degree in Business, Finance, Computer Science, Engineering, Economics, or a related field preferred 3-5 years of experience in healthcare claims analytics, payer operations, revenue recovery, or related healthcare functions requiredExperience working with health plans, provider organizations, or value-based care environments preferred Knowledge of healthcare reimbursement methodologies including DRGs, Revenue Codes, CPT Codes, HCPCS Codes, and bundled payments Strong understanding of healthcare claims processing, eligibility, and reimbursement cycles Knowledge of institutional and professional billing and various sites of care Advanced proficiency in Microsoft Excel requiredExperience with Power BI, Tableau, and/or Microsoft SQL preferred Certified Subrogation Recovery Professional (CSRP) certification preferred Strong analytical, financial, and problem-solving skills Exceptional attention to detail and accuracy Excellent written and verbal communication abilities Ability to manage multiple priorities in a fast-paced environment Strong project management and organizational skills Ability to work independently while collaborating effectively across departments Bilingual English and Spanish preferred Join a team dedicated to improving healthcare outcomes through operational excellence and financial stewardship. At Community Medical Group, you'll have the opportunity to make a meaningful impact by helping maximize revenue recovery, strengthen payer relationships, and support the continued delivery of high-quality care to the communities we serve.