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Job 26066

San Diego, CA

Job Title:
Reimbursement Specialist II (Kearny Mesa)

Long Term Temp (> 30 Days)


A large healthcare organization in San Diego is seeking a Reimbursement Specialist II. Under the direction of PFS Leadership, the Reimbursement Specialist II is responsible for billing & collections of outstanding account balances for commercial, government, & managed care payors as assigned. The Reimbursement Specialist II is required to identify & report payor issues to their leadership. It is a requirement for the Reimbursement Specialist II to read, interpret & apply complex payor contract language to expected reimbursement calculations & pursue all payments due to the organization. The Reimbursement Specialist II must perform account collection activities utilizing internet resources & professional telephone communication etiquette. The Reimbursement Specialist II is required to compose professional written correspondence with all internal & external entities. This position expects the Reimbursement Specialist II to demonstrate organization & time management skills to manage account collections. The Reimbursement Specialist II identifies payer trends in regards to denials/underpayments & makes appropriate recommendations. Works with payers to resolve denial & underpayment trends. Has a thorough knowledge of the revenue cycle & able to identify process problems impacting AR. Incumbent has a thorough knowledge of industry & payer billing requirements to include claim form requirements & revenue codes. Uses appropriate resources for investigation of denials to include payer guidelines & the UB editor.

Basic Qualifications:

  • H.S. Diploma, GED, or Equivalent  
  • At least 5 years of experience or 2 years in a Reimbursement Specialist l position exceeding performance expectations with a minimum of a high solid rating evaluation
  • Proficient in Microsoft Excel, Word and Outlook programs.
  • Proficient in determining appropriate appeals or adjustments based upon analysis of the denial codes, charges, revenue codes, CPT codes, HCPCS codes, & ICD-9 (10) diagnosis/procedure codes.

Preferred Qualifications:

  • Associate's Degree  
  • 5+ years of experience or 2+ years in a Reimbursement Specialist l position exceeding performance expectations with a minimum of a high solid rating evaluation
  • Certification as a HFMA Credentialed Revenue Cycle Representative


All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Minimum Years of Experience:

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