Reimbursement Specialist

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

📋 Description

• Accurately submit clean claims to both primary and secondary payers in a timely manner.

• Review, amend, and swiftly resubmit any claims that have been rejected or denied.

• Confirm insurance eligibility, authorizations, and necessary documentation prior to medication delivery.

• Maintain comprehensive patient billing files, including CMNs, prescriptions, and medical documentation.

• Verify delivery dates before submitting claims and invoice patients for any applicable responsibility amounts.

• Collaborate with pharmacy, care coordination, and field staff to address billing issues.

• Monitor accounts receivable activity and keep detailed reports on AR status.

• Communicate with insurance companies, providers, and internal teams regarding claim status updates.

• Anticipate cash flow based on claim progress and payer response trends.

• Document all payer communications and follow-up actions taken.

• Address payer requests for records, authorizations, and clinical documentation promptly.

• Assist in maintaining insurance contracts and support payer audits.

• Keep an eye on payer behavior, coverage changes, and industry developments, escalating any concerns as needed.

• Engage in quality assurance efforts, audits, training, and ongoing education initiatives.

⛳️ Requirements

• Minimum of two years of experience in medical insurance or reimbursement.

• Exceptional attention to detail and capability to handle multiple priorities effectively.

• Strong verbal and written communication abilities.

• Proficiency in billing systems, payer portals, and Microsoft Office applications.

• A robust customer service orientation and professionalism when addressing complex payer issues.

• Organizational skills and adaptability in a dynamic workload environment.

• Availability to work from 8:30 AM to 5:00 PM CST or EST.

• Commitment to participate annually in mandatory legal and ethical compliance training.

• Adherence to LUX Infusion’s legal, ethical, and compliance policies as outlined in the Compliance Manual.

• Home infusion or specialty pharmacy reimbursement experience is preferred but not required.

• Familiarity with CPR+ and/or CareTend systems is preferred but not required.

• Certified Pharmacy Technician credentials are preferred but not mandatory.

• Experience assisting patients with chronic or rare conditions is preferred but not required.

• Capability to occasionally stand, walk, sit, use hands, reach, climb stairs, balance, stoop, kneel, crouch, crawl, talk, and hear.

• Ability to occasionally lift and/or move items weighing up to 25 pounds.

🏝️ Benefits

• Work that is purpose-driven and directly supports patient care.

• A patient-first, clinician-led culture.

• Collaborative teams that span pharmacy, revenue cycle, and care coordination.

• Opportunities to deepen expertise in specialty infusion reimbursement.

• Reasonable accommodations available for individuals with disabilities.