Medical Claims Processor

Valora Medical Group is a visionary company focused on high-quality primary care services and consisting of healthcare providers and professionals dedicated to the health and well-being of our patients. At Valora, we treat our patients like family.

With multiple locations throughout the Dallas Fort-Worth and Orlando area, we understand that providing quality medical care and exceptional patient experience across all our centers requires having an outstanding team. We recognize the hard work that our team members put in and offer competitive pay, excellent benefits, and a dynamic work environment.

We're looking for an upbeat and positive individual to join our team! Submit your resume today and join us in our commitment to working together to provide a “Best-in-Class” service!

Valora Medical Group is seeking a detail-oriented Medical Claims Processor to support our primary care practices by ensuring clean, accurate, and compliant claim submission. This role functions as a medical claim scrubber, reviewing outpatient and preventive care claims for accuracy prior to submission. By combining automated claim-scrubbing tools with manual review, the Medical Claims Processor helps minimize denials, speed reimbursement, and maintain compliance with CMS, HIPAA, and payer-specific guidelines common to primary care settings.

• Review primary care claims for accuracy, including patient demographics, provider NPI, place of service, and ICD-10/CPT/HCPCS coding
• Validate diagnosis-to-procedure linkages for office visits, preventive services, chronic care management, and common primary care procedures
• Identify and correct missing, invalid, or mismatched codes prior to claim submission
• Ensure adherence to payer-specific rules for primary care services, including preventive care coverage, wellness visits, and evaluation & management (E/M) coding
• Verify authorization requirements, modifiers, and frequency limitations
• Confirm accuracy of patient identifiers, insurance information, and provider credentials to align with payer records
• Investigate and resolve errors flagged by automated claim-scrubbing software
• Work closely with clinical, coding, and billing teams to resolve documentation or coding discrepancies
• Submit clean, validated outpatient claims electronically through clearinghouses
• Support timely reimbursement by ensuring claims meet all payer and regulatory requirements
• Any additional duties as assigned by management

• Proven experience in medical billing, claims processing, or coding within a primary care or outpatient setting
• Experience with denial prevention and resolution preferred
• Strong understanding of primary care billing workflows, including E/M coding, preventive services, and chronic care management
• Solid knowledge of medical terminology and coding systems (ICD-10, CPT, HCPCS)
• Familiarity with HIPAA and CMS guidelines
• Proficiency with EHR and practice management systems such as eClinical
  
  Works (eCW) or Next Gen
• Experience using clearinghouses such as Availity or Waystar
• Exceptional attention to detail and accuracy
• Strong analytical and problem-solving skills
• Ability to manage multiple priorities in a fast-paced primary care environment

Valora Medical Group, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law. In compliance with the Immigration Reform and Control Act of 1986, we will hire only U.S. citizens and aliens lawfully authorized to work in the United States.