Reimbursement Specialist

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

📋 Description

• Oversee the complete billing and collections process for a specified portfolio of Workers’ Compensation and Personal Injury prescription claims

• Manage and diligently work on a minimum of 40+ patient accounts

• Assess and prioritize aging reports on a daily basis to decrease 60/90/120+ day accounts receivable and expedite reimbursement

• Evaluate EOBs, notices of disallowance, state fee schedule discrepancies, and payment variances

• Implement resolution strategies such as corrected claim submissions, appeals, outreach to adjusters, escalation, and legal follow-up

• Monitor and resolve unpaid and underpaid claims in line with contractual agreements and state fee schedules

• Prepare and submit timely appeals, ensuring all medical and billing documentation is complete

• Review and correct demographic data, insurance information, ICD-10 diagnoses, CPT codes, and billing modifiers

• Detect denial trends and recurring issues with payers, while contributing to process enhancements

• Maintain comprehensive account documentation for compliance, reporting, and follow-up purposes

• Liaise with insurance carriers, adjusters, attorneys, and internal clinical teams

• Achieve or surpass KPIs related to AR reduction, collection rate enhancement, appeal success, productivity, quality, and accuracy

• Assist with special projects and initiatives aimed at improving the revenue cycle

⛳️ Requirements

• At least 2 years of experience in medical billing and collections (preferred)

• Strong preference for candidates with Workers’ Compensation billing experience

• In-depth knowledge of EOB interpretation

• Familiarity with ICD-10 coding

• Experience in denial management

• Proven track record with appeals and follow-up with insurance carriers

• Strong analytical and problem-solving abilities

• Exceptional attention to detail and capacity to manage multiple accounts simultaneously

• Excellent written and verbal communication skills

• Proficient in Microsoft Excel

• Ability to operate independently in a fast-paced, growth-focused environment

• Preferred: 1 year of experience billing for medications/pharmacy-related services

• Preferred: 1 year of experience in Workers’ compensation billing and claims

🏝️ Benefits

• 401(k)

• Dental insurance

• Flexible spending account

• Health insurance

• Life insurance

• Paid time off

• Referral program

• Vision insurance

• Remote work arrangement

• Monday-Friday schedule, 8:00am to 5:00pm