Reimbursement Specialist

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

📋 Description

• Conduct research and monitor billing challenges, trends, and potential risks.

• Review claims to ensure their accurate submission, meeting all pre-claim requirements.

• Track the status of claims and generate reports, particularly using Excel.

• Analyze denied or unpaid claims and implement corrective measures, including resubmissions and appeals.

• Provide administrative assistance, including data entry and updating record-keeping systems.

• Navigate payer portals, websites, and phone systems to verify eligibility, prior authorization, claim, and appeal statuses.

• Incorporate payer guidelines and policies into daily decision-making processes.

• Support patients throughout their financial journey.

• Verify insurance and recipient benefits with Medicare, Medicaid, and private insurance providers.

• Accurately and promptly complete billing tasks on a daily basis.

• Review and interpret explanations of benefits.

• Collaborate with insurance companies, internal teams, customers, and patients to facilitate timely reimbursement.

⛳️ Requirements

• High school diploma or GED.

• Associate's or bachelor's degree in healthcare administration, business, or a related field is preferred.

• Proficient in the use of personal computers, computer applications, and general office equipment.

• Experience with Microsoft Office, particularly Word and Excel.

• A minimum of 2 years of experience in medical billing, insurance claims, or revenue cycle operations.

• Familiarity with payer portals and claim tracking systems.

• Understanding of HIPAA compliance and healthcare privacy regulations.

• Experience with CRMs such as Salesforce and billing software like Epic, XiFin, and Quadax.

• Strong analytical, interpersonal, communication, organizational, numerical, and time management skills.

• Capability to meet deadlines and manage multiple projects simultaneously.

• Familiarity with ICD and HCPCS/CPT coding is preferred.

• Knowledge of the CMS 1500 claim form is preferred.

• Understanding of Claim Adjustment Reason Codes (NUCC) is preferred.

🏝️ Benefits

• Competitive compensation and benefits package.

• Potential eligibility for additional discretionary bonuses or incentives.

• Potential eligibility for restricted stock units.

• Opportunities for career advancement.

• An inclusive workforce and workplace environment.