Reimbursement Coordinator II

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Verify patient insurance benefits, coverage eligibility, and prior authorization requirements

• Initiate, submit, and track prior authorization requests with Medicare, Medicaid, and commercial payers

• Coordinate the collection and review of clinical documentation, medical records, coding information, and necessary forms

• Monitor authorization status and follow up with provider offices and payers to facilitate timely coverage decisions

• Analyze authorization denials and assist with reconsideration, resubmission, and appeal activities

• Interpret payer coverage policies, reimbursement requirements, and criteria for authorization

• Collaborate with field personnel and healthcare provider offices to offer guidance on authorization processes and payer requirements

• Maintain precise case records, reporting data, and reimbursement resources

• Support operational audits, productivity monitoring, and process enhancements

⛳️ Requirements

• High School Diploma with a minimum of 2 years of experience in prior authorization, reimbursement, healthcare revenue cycle, payer operations, insurance verification, or patient access support

• Experience with Medicare, Medicaid, and commercial payer authorization processes

• Experience in reviewing and coordinating medical documentation for prior authorization submissions

• Proficiency in Microsoft Excel and familiarity with case management, customer relationship management (CRM), or healthcare workflow systems

• Ability to manage multiple cases concurrently while adhering to quality and turnaround standards

• Unrestricted U.S. work authorization at the time of hire and throughout employment

• An Associate's or Bachelor's degree is preferred

• American Academy of Professional Coders (AAPC) Coding Certification is preferred

• Experience in supporting medical device, neuromodulation, or healthcare reimbursement programs is preferred

• Knowledge of ICD-10 and Current Procedural Terminology (CPT) coding is preferred

• Experience with Salesforce and healthcare reimbursement or patient access platforms is preferred

• For degrees obtained outside of the United States, a degree that meets the stipulations of 8 C.F.R. § 214.2(h)(4)(iii)(A) is required

🏝️ Benefits

• Competitive salary and flexible benefits package

• Health, dental, and vision insurance

• Health Savings Account

• Healthcare Flexible Spending Account

• Life insurance

• Long-term disability leave

• Dependent daycare spending account

• Tuition assistance/reimbursement

• Simple Steps (global well-being program)

• Incentive plans

• 401(k) plan with employer contribution and match

• Short-term disability

• Paid time off

• Paid holidays

• Employee Stock Purchase Plan

• Employee Assistance Program

• Non-qualified Retirement Plan Supplement

• Capital Accumulation Plan (available to Vice Presidents and above, or subject to IRS earning minimums)

• Temporary employees are eligible for paid sick time as mandated by applicable state law, as well as the Employee Stock Purchase Plan