Provider Reimbursement and Claims Specialist
- Application Deadline: Feb. 6, 2026
- San Francisco
- On-site
- Hourly salary: $18 - $20
Key Responsibilities
- Perform manual review and pricing of complex and non-standard claims
- Interpret hospital, medical group, and provider contracts to determine reimbursement
- Apply fee schedules, payment methodologies, and regulatory requirements
- Maintain and manage pend queues and claim inventory
- Review claims for correct CPT, HCPCS, and ICD-10 coding
- Validate medical necessity, exclusions, and benefit limitations
- Investigate and resolve complex claim edits and payment issues
- Make independent decisions on claim payments and adjustments
- Act as a Subject Matter Expert (SME) for claims operations
- Participate in User Acceptance Testing (UAT) for system and contract updates
- Identify system issues and recommend process improvements
- Work independently with minimal supervision
Skills & Requirements
Required Qualifications
- 2–3 years of medical claims or billing experience
- Strong experience in manual claim adjudication and pricing
- Proven ability to interpret provider contracts and fee schedules
- Hands-on experience with claims processing systems
- Working knowledge of:
- CPT
- HCPCS
- ICD-10
- Medical terminology
- Strong attention to detail and analytical skills
- Ability to work independently and manage time effectively
- Comfortable making decisions in ambiguous situations
Education
- High school diploma or GED required
Preferred Qualifications
- Experience with out-of-network claims
- Familiarity with health plan policies and regulatory guidelines
- Prior experience in health insurance or managed care
- Strong written and verbal communication skills
About the company
Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields.
Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.
Sathish Kumar | Contact Person
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