Reimbursement Specialist

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

📋 Description

• Oversee the entire reimbursement process, encompassing claim preparation, submission, and follow-up on accounts.

• Assess claims and billing documentation for precision and thoroughness prior to submission.

• Process claims via TrueSight, payer portals, and invoicing systems for insurance, resellers, alternate funding, and other unconventional reimbursement methods.

• Track submitted claims and invoices to ensure prompt processing, payment, and resolution of any outstanding balances.

• Communicate with insurance companies, patients, caregivers, resellers, and other external stakeholders to address payment discrepancies.

• Detect and rectify claim denials, billing mistakes, and submission challenges.

• Examine claim denials, underpayments, and outstanding balances while executing resolution strategies.

• Prepare appeals and accompanying documentation for denied or underpaid claims.

• Handle patient financial obligations, including payment plans, payment links, and payment resolution prior to shipment and case closure.

• Supervise and manage assigned Accounts Receivable to minimize aging balances and aid collection targets.

• Keep precise records of billing, collection, and account activities.

• Collaborate with internal teams to identify trends, overcome reimbursement obstacles, and enhance billing and collection procedures.

• Ensure adherence to payer requirements, reimbursement regulations, company policies, and HIPAA standards.

• Stay updated on payer requirements, billing procedures, reimbursement guidelines, and industry regulations.

• Perform additional duties as required.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• 1–3 years of experience in medical reimbursement, Durable Medical Equipment (DME), medical billing, or healthcare revenue cycle management.

• 1–3 years of experience with medical billing or claims management software, such as TrueSight.

• 1–3 years of experience using payer and/or clearinghouse portals, such as MyCGS or Inovalon.

• Exceptional attention to detail, organizational, problem-solving, and follow-up abilities.

• Strong written and verbal communication capabilities.

• Capability to effectively juggle multiple and changing priorities in a dynamic environment.

• Willingness to travel within the U.S. up to 2 times a year for in-person team and company-wide meetings, with potential additional travel for conferences and events.

• Experience overseeing both billing and collections activities throughout the reimbursement lifecycle.

• Familiarity with managing patient balances, payment plans, and electronic payment solutions.

• Proficient in Microsoft Office applications, especially Excel and Outlook.

• Knowledge of TrueSight and/or Inovalon.

• Experience handling confidential or protected health information in a healthcare setting.

• Understanding of HIPAA and healthcare privacy regulations.

• Experience with DMEPOS reimbursement, particularly relating to Medicare DMEPOS.

• Authorization to work in the U.S., verified through E-Verify.

🏝️ Benefits

• Comprehensive benefits package.

• Ability to work remotely from a home office.

• Opportunities for travel to in-person team and company meetings, conferences, and events.

• Reasonable accommodations for individuals with disabilities.

• An inclusive and supportive work environment.

• Fair and equitable compensation practices.

• Support for career growth.