Reimbursement Specialist

Job Description

Job Description

Job Summary:

The Reimbursement Specialist is responsible for the accurate and timely processing, follow-up, and resolution of medical claims to ensure proper reimbursement for services rendered. This role focuses on primary care billing and requires a deep understanding of insurance processes, payer requirements, and regulatory billing guidelines. The ideal candidate is highly detail-oriented, efficient in payer communication, and knowledgeable in all aspects of insurance claims, denials, and reconciliation processes. This is a temporary position going through the end of 2025.

Main Duties and Responsibilities:

• Review, analyze, and perform timely follow-up on both primary and secondary claims.

• Resolve rejections and denials, submit adjustments, and ensure full reconciliation of payments.

• Interpret and respond to payer rejection and denial reason codes to ensure accurate and complete resubmission of claims, with a focus on primary care services.

• Conduct insurance eligibility verifications and interpret coverage accurately, especially for residents and patients in a primary care setting.

• Utilize payer portals and systems to submit appeals, interpret claim status information, and respond to payer communications relevant to the revenue cycle.

• Apply appropriate billing actions based on payer-specific guidelines and revenue cycle needs.

• Review, manage, and submit accurate third-party claims for Physician and Nurse Practitioner services to Medicare, HMOs, and commercial payers.

• Reconcile payments to ensure claims are paid in alignment with contractual agreements; identify discrepancies such as overpayments or underpayments and submit corrected claims as needed.

• Maintain up-to-date knowledge and application of federal and state billing regulations.

• Perform EMR accounting functions including claim adjustments and bad debt write-offs as necessary.

Qualifications:

• High school diploma or equivalent; Associate's or Bachelor's degree in healthcare administration, business, or related field preferred.

• Minimum 2-3 years of experience in medical billing and reimbursement, preferably in a primary care setting.

• Strong understanding of insurance plans, eligibility verification processes, and payer guidelines.

• Familiarity with EMR/EHR systems and billing software.

• Proficiency in interpreting payer remittance advices, EOBs, etc.

• Excellent communication, analytical, and problem-solving skills.

Beacon Hill is an equal opportunity employer and individuals with disabilities and/or protected veterans are encouraged to apply.

California residents: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

If you would like to complete our voluntary self-identification form, please click here or copy and paste the following link into an open window in your browser: https://jobs.beaconhillstaffing.com/eeoc/

Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for reporting purposes only and will be kept separate from all other records.

Company Profile:

Founded by industry leaders to set a new standard in search, career placement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, a commitment to project completion and success and a passion for innovation, creativity and continuous improvement.

Our niche brands offer a complete suite of staffing services to emerging growth companies and the Fortune 500 across market sectors, career specialties/disciplines and industries. Over time, office locations, specialty practice areas and service offerings will be added to address ever changing constituent needs.

Learn more about Beacon Hill and our specialty divisions, Beacon Hill Associates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal, Beacon Hill Life Sciences and Beacon Hill Technologies by visiting www.bhsg.com.

Benefits Information:

Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings.

We look forward to working with you.

Beacon Hill. Employing the Future™