Reimbursement Specialist II

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

📋 Description

• Monitor, report, and resolve intricate outstanding claims

• Analyze Explanation of Benefits (EOBs) to identify the causes of claim denials or inadequate payments

• Challenge non-covered or underpaid claims via external review processes

• Follow up on unresolved claims to ensure prompt resolution

• Promote favorable coverage determinations through external appeals

• Keep precise records of payer communications, correspondence, and insurance inquiries

• Work in collaboration with the billing tool provider, finance, and client services teams to enhance billing operations and maximize reimbursement processes

⛳️ Requirements

• Over 2 years of experience in a healthcare reimbursement position

• Strong knowledge of health plan regulations, billing procedures, and interactions with payers

• Preferred experience with appeals at state and external review levels (IRO/IRBs)

• Highly organized with a keen attention to detail

• Self-motivated individual capable of working autonomously with minimal oversight

• Tech-savvy and analytical, proficient in troubleshooting complex issues

• Outstanding written and verbal communication abilities, particularly in challenging situations

• Moderate proficiency in Excel (including sorting, filtering, and basic calculations)

• Familiarity with laboratory billing, Xifin, EDI enrollment, payer portals, merchant solutions, and national/regional payers is advantageous

• Capability to work during PST hours

• Background screening, including criminal history, is mandatory

• Ability to remain seated for extended durations

• May need to lift routine office materials and operate office equipment

🏝️ Benefits

• Remote work option

• Flexible work-life balance with work-from-home days (when applicable)

• Reasonable accommodations provided during the hiring process

• Equal Opportunity Employer

• Confidential management of applicant information