Medical Billing Specialist

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.

* 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.

* 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.

Healthcare Insurance Data Management opportunity in Livermore, CA! 100% onsite role supporting payer contracts, reimbursement methodologies, billing rules, Medicare/Medicaid plans, and revenue cycle operations. 2+ years healthcare insurance experience required.