Healthcare Reimbursement Specialistin San Francisco, CA + Drive Revenue Integrity

Join a dynamic healthcare organization at the forefront of optimizing financial operations. We’re seeking a meticulous and proactive Healthcare Reimbursement Specialist to join our dedicated team in San Francisco, CA. In this pivotal role, you’ll play a critical part in ensuring accurate billing, maximizing revenue capture, and maintaining compliance across complex healthcare reimbursement processes. If you thrive on precision, possess a deep understanding of insurance billing intricacies, and are passionate about driving financial health, this is your opportunity to make a significant impact.

About the Role

As a Healthcare Reimbursement Specialist, you’ll be the cornerstone of our revenue cycle management. Your primary responsibility will be to review, analyze, and process complex medical claims with unwavering accuracy. You’ll navigate intricate insurance policies, resolve billing discrepancies, and ensure timely reimbursement for services rendered. This role demands exceptional attention to detail, strong analytical skills, and the ability to communicate effectively with both internal teams and external payers. You’ll work collaboratively within our finance department to identify trends, implement process improvements, and uphold the highest standards of compliance and revenue integrity.

Key Responsibilities

• Thoroughly review medical claims for completeness, accuracy, and adherence to payer-specific guidelines and regulations (including HIPAA, CPT, ICD-10, and DRG coding).
• Process claims efficiently and accurately through the entire billing cycle, from initial submission to final payment posting.
• Investigate and resolve claim denials, rejections, and underpayments by researching payer policies, verifying patient eligibility, and coordinating with clinical staff.
• Maintain detailed knowledge of current and evolving healthcare reimbursement methodologies, including fee schedules, contractual agreements, and coding updates.
• Prepare and submit appeals for denied claims, ensuring thorough documentation and compelling rationale.
• Collaborate with the finance team, clinical departments, and billing vendors to streamline processes and enhance revenue collection.
• Contribute to ongoing process improvement initiatives aimed at increasing efficiency and reducing errors.

Requirements

Essential Qualifications

• High school diploma or equivalent; Associate’s degree in Healthcare Administration, Business, or a related field preferred.
• Minimum of 2 years of verifiable experience in healthcare billing, claims processing, or a related financial role within a healthcare setting (hospital, clinic, or billing company).
• Proven expertise in medical billing software (e.g., EPIC, Cerner, Meditech, or similar) and proficiency with common billing codes (CPT, ICD-10, HCPCS).
• Deep understanding of insurance billing processes, including Medicare, Medicaid, and commercial payer requirements.
• Exceptional attention to detail, accuracy, and organizational skills; ability to manage multiple priorities in a fast-paced environment.
• Strong analytical and problem-solving skills; ability to identify root causes of billing issues and implement solutions.
• Excellent written and verbal communication skills; ability to explain complex billing concepts clearly to diverse audiences.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook).

Desired Qualifications

• Certified Medical Reimbursement Specialist (CMRS) or Certified Professional Biller (CPB) designation.
• Experience with specific billing systems used by large healthcare systems or payer organizations.
• Knowledge of healthcare compliance regulations (OIG, Stark, etc.).
• Experience in a leadership or supervisory capacity within billing.
• Understanding of revenue cycle management (RCM) best practices.

Benefits

We value our team members and offer a comprehensive benefits package designed to support your well-being and future:

• Competitive Compensation: Salary range: $65,000 – $85,000 USD/year based on experience and qualifications.
• Health & Wellness: Comprehensive health, dental, and vision insurance options.
• Financial Security: 401(k) plan with company match and generous paid time off (PTO).
• Professional Growth: Opportunities for continuing education, certifications, and career advancement.
• Work-Life Balance: Flexible scheduling options and a supportive, collaborative work environment.
• Additional Perks: Employee assistance program, wellness stipends, and team-building activities.

Ready to Drive Revenue Integrity?

If you possess the expertise, dedication, and passion for optimizing healthcare financial operations, we want to hear from you. Submit your resume and a compelling cover letter detailing your experience in healthcare reimbursement and your interest in contributing to our mission in San Francisco, CA. Join us in building a more efficient and effective healthcare financial future.

Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.