Provider Reimbursement and Claims Specialist

San Francisco, CA - USA

Monthly Salary: $ 18 - 20

Posted on: 21 hours ago

Vacancies: 1 Vacancy

Job Summary

Application Deadline: Feb. 6 2026
San Francisco
On-site
Hourly salary: $18 - $20

Job Description

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

Required Experience:

Application Deadline: Feb. 6 2026 San FranciscoOn-siteHourly salary: $18 - $20Job DescriptionKey ResponsibilitiesPerform manual review and pricing of complex and non-standard claimsInterpret hospital medical group and provider contracts to determine reimbursementApply...