Full-Time Reimbursement Specialist

Reimbursement and Prior Authorization Specialist

As a Reimbursement and Prior Authorization Specialist, you will drive payment by contacting insurance companies to secure preauthorization. You will ensure information is complete and accurate, follow up on requests, and apply knowledge of Medicare, Medicaid, and other payer requirements. You will optimize billing processes. You will help develop and maintain a database of payer authorization requirements, and manage documentation. You are responsible for tracking and addressing outstanding claims.

Responsibilities include:

• Contacting insurance companies for preauthorization.
• Ensuring accurate and complete information.
• Following up on requests and applying knowledge of payer requirements.
• Facilitating optimized billing processes.
• Developing and maintaining a payer authorization database.
• Managing documentation for payer communication.
• Tracking, reporting, and addressing outstanding claims.
• Troubleshooting EOBs and appealing claims.

Qualifications:

• 3+ years experience in healthcare reimbursement.
• Knowledge of health plan regulations.
• Moderate Excel skills (sorting, filtering, calculations).
• Experience with a broad range of payers.
• Coordination experience with insurance providers, physicians, and patients.
• Experience appealing to state agencies or external reviews.
• Familiarity with laboratory billing, Xifin, EDI, etc. (preferred).

What is the last date for applying to the job?

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