Jobs

Description

Medical Billing- (Insurance Data Management Specialist)

Position located 100% onsite in Livermore, CA

No remote, hybrid, or part-time candidates will be considered.

Work Hours: Monday–Friday, 6am-2:30pm PST Must be able to commit to working these hours

Top Skills/Experience

• Working knowledge of commercial, Medicare, Medicaid, and managed care insurance plans.
• Strong analytical, organizational, and problem-solving skills
• Minimum 2 years of experience in healthcare insurance, revenue cycle management, eligibility verification, billing, or insurance data management.

Job Title: Insurance Data Management Specialist

Position Summary

• The Insurance Data Management Specialist is responsible for the setup, maintenance, auditing, and optimization of payor-related system configurations across revenue cycle platforms.
• This role ensures accurate implementation of payor contracts, reimbursement methodologies, billing rules, fee schedules, and claims processing requirements to support compliant and efficient revenue cycle operations.

Key Responsibilities

• Configure and maintain payor plans, reimbursement methodologies, fee schedules, contractual allowances, and billing rules.
• Implement new payor contracts and update existing configurations based on contract amendments and reimbursement changes.
• Support Billing, VOB, Prior Authorization, and Collections teams with insurance research and payer-related inquiries.
• Investigate claim status issues and assist in identifying payer-related root causes affecting reimbursement.
• Ensure configurations comply with contractual obligations, payer policies, and regulatory requirements.
• Develop and maintain payer reference materials, workflows, and process documentation.

 Required

• High school diploma or equivalent.
• Minimum 2 years of experience in healthcare insurance, revenue cycle management, eligibility verification, billing, or insurance data management.
• Working knowledge of commercial, Medicare, Medicaid, and managed care insurance plans.
• Strong understanding of healthcare reimbursement and payor contract interpretation.
• Experience researching payer policies and insurance requirements.
• Strong analytical, organizational, and problem-solving skills.
• Excellent communication and collaboration skills.