Reimbursement Specialist

Title:- Reimbursement Specialist 
Location:- San Diego, CA
Duration:-  3 Months Contract
Tax Term: W2 
Schedule: Mon. - Fri., 8:00 a.m. - 5:00 p.m.
Job Description:
·         The Director is looking for three Reimbursement Specialist I's for their Patient Financial Services. The job seekers must have prior or current Medi-Cal billing experience
·         Under the direction of PFS Leadership, the Reimbursement Specialist I is responsible for billing & collections of outstanding account balances for commercial, government, & managed care payors as assigned. 
·         The Reimbursement Specialist I is required to identify & report payor issues to their leadership. 
·         It is a requirement for the Reimbursement Specialist I to read, interpret & apply complex payor contract language to expected reimbursement calculations & pursue all payments due to the organization. 
·         The Reimbursement Specialist I must perform account collection activities utilizing internet resources & professional telephone communication etiquette. 
·         The Reimbursement Specialist I is required to compose professional written correspondence with all internal & external entities. 
·         This position expects the Reimbursement Specialist I to demonstrate organization & time management skills to manage account collections. 
School Education 
• Associate's Degree (Preferred) 
• H.S. Diploma,GED,or Equivalent (Minimum) 
• 2 Years of Experience (Minimum) 
• 3 Years of Experience (Preferred) 
Skills & Qualities 
• (Minimum) Proficient in Microsoft Excel, Word and Outlook programs. 
Quality 1 
Resolve all claim edits, stop bills, & account edits including late charges, charge errors, consecutive accounts, duplicate accounts, & claim errors in order to submit timely & accurate claims to government agencies, commercial payers, & other payers as assigned in accordance with federal, state, industry regulations & standards. Knowledge of HIPAA billing requirements to include claims (UB & 1500 current versions), & basic CPT coding, ICD 9/ICD10. 
Quality 2 
Ability to read & apply complex contractual arrangements to identify expected reimbursement to include fee schedules, per diems, high dollar stop loss, DRGs, APCs, & carve outs. 
Quality 3 
Review all denials/underpayments & take corrective action based upon national denial reason codes, remark codes & payer specific codes. Must understand payor-specific requirements & utilize payer websites, procedural billing manuals, & standard operating procedures. 
Quality 4 
Processes overpayments within the guidelines of federal & state regulations, payer requirements, & hospital standard procedures. 
Quality 5 
Receives & processes requests from patient families, insurance carriers, government entities, & other sources. Must provide appropriate requested information to ensure quality customer service & appropriate adjudication of claims. Compliant with Federal, state, & hospital regulations to ensure privacy is maintained in compliance with HIPAA. 
Quality 6 
Follows prescribed workflow & prioritization to ensure all accounts are being submitted & followed up on in a timely manner to include credit balances, high dollar accounts, & aging accounts. Meets department quality & productivity standards
Your prompt response is highly appreciated.
Thanks and have a blessed day ahead. 
Thanks and Regards,
Srinivas Mallipog
Resource Executive
APN Software Services, Inc (
39899 Balentine Drive, Suite 385, Newark, CA 94560
Phone: 510-623-5050- Extn 139 / Direct: 510-943-4054
Fax: 510-623-5055 
Email Id:

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