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Job Title: Payment Reveiw Specialist
Job Description:
We are seeking a detail-oriented Reimbursement Specialist to review remittance advice and ensure accurate payment from third-party insurance carriers. This role involves verifying payments against contract terms, resolving reimbursement discrepancies, and processing refunds or re-billing as needed. The ideal candidate will be familiar with insurance contracts, claims processing, and hospital billing systems (HIS). Strong communication skills are essential for interacting with payers, patients, and internal teams. HBI certification is required by the end of the probationary period.
Responsibilities/ Job Duties:
Review remittance advice to verify appropriate insurance reimbursement per contract terms.
Cross-check reimbursement amounts with HIS system expectations.
Investigate and resolve payment discrepancies or underpayments.
Process charge adjustments, allowances, and initiate refunds to patients or insurers.
Recode accounts and enter updates into HIS for re-billing purposes.
Handle denials by reviewing and processing rejections from insurance carriers.
Contact insurance companies for additional payments or credit resolution.
Escalate payer or contract-related issues to management or provider representatives.
Respond to patient inquiries regarding billing issues or incomplete information.
Support phone inquiries and assist in general billing tasks as needed.
Maintain compliance with WPH policies and HBI certification requirements.
Benefits:
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)
- Health Benefits / Dental / Vision (Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s).)
- 401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)
- Short Term Disability Insurance
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
