Reimbursement Specialist - Healthcare jobs in Santa Clara, CA

Reimbursement Specialist
Full-Time
Hybrid/Remote

• Review Government and Non-Government Payer claims for accuracy, completeness and compliance with
  payer requirements.
• Review daily prebilling reports and communicating to the health centers when information is needed to bill
  the encounters.
• Responsible for correcting all claim edits in EPM and clearinghouse
• Address questions from health center staff regarding issues which may include but are not limited to
  patient eligibility, data entry, coding and other payer requirements.
• Address questions from patients regarding explanation of benefits and refunds.
• Work assigned reports to ensure timely follow up is performed including but not limited to: researching and determining the cause of the denial, rebilling or contacting payers via phone, website, RTD, CIF, Tracer or formal Provider Dispute process to resolve payment, denial and billing issues.
• Review and work claim rejection letters from payers and submit necessary information for claim payment.
• Adhere to department’s policy, procedures and billing guidelines and timelines.

• Serve as back up for other employees for breaks and absences as needed.
• Assist in providing information and materials for annual audit of affiliate’s financial records.
• Works with and provides training for volunteers/interns as applicable.
• Performs other duties as assigned.
   

• High School Diploma and three to five years of experience in Medical Billing and Collections required.
• Three to five years of current Practice Management System experience preferred
   

• In depth knowledge of Government and Non-Government payer sources and demonstrated proficiency in
  the interpretation of carrier contracts.
• Knowledge of CPT4/ICD9/HCPCS codes.
• Strong oral and written communication skills
• Proficiency in Microsoft Office Suite with excellent knowledge of Microsoft Excel.
• Multi-tasking and attention to detail is required.
• Research skills to interpret new medical and insurance industry terminology
• Ability to resolve problems with rejected or disputed claims.
• Ability to effectively communicate with health care professionals and third-party providers on payment and
  claim issues.