Full-Time Reimbursement Specialist II

About the Role: As a Reimbursement Specialist II, you'll ensure accurate and timely reimbursements. Collaborate with billing, finance, and client services to optimize billing, enhance efficiency, and uphold company standards.

Essential Duties and Responsibilities:

• Monitor and manage complex outstanding insurance claims for timely resolution.
• Troubleshoot Explanation of Benefits (EOBs) and identify claim denial reasons.
• Prepare and submit appeals for non-covered services, low payments, or disputed claims.
• Maintain detailed documentation of payer communications, claim statuses, and research activities.
• Collaborate with internal and external payers to resolve billing issues.

Requirements:

• 3+ years experience in healthcare reimbursement.
• Solid understanding of health plan regulations, payer policies, and claims processing.
• Basic proficiency in Excel (sorting, filtering, simple formulas).
• Proactive, organized, detail-oriented, and passionate about problem-solving.
• Strong communication skills for navigating complex scenarios and building relationships.
• Proven ability to work independently, prioritize tasks, and manage multiple claims.
• Experience working with diverse payers (state agencies, IRO/IRB reviews, external reviews).
• Familiarity with laboratory billing systems, Xifin, EDI enrollment, payer portals, and regional/national payers (preferred).

Work Model: Hybrid model with defined in-person/onsite days and work-from-home days.

Salary: $24.15 - $33.22/hour (full-time).

Additional Info:

• Employee may be required to lift light items and use office equipment.
• Work primarily in an office environment, but may be exposed to high noise levels, fumes, and biohazard material.
• Ability to sit for extended periods.
• Company commitment to reasonable accommodations for disabilities, long-term conditions, mental health conditions, and sincerely held religious beliefs.
• Equal Opportunity Employer.

What is the last date for applying to the job?

Which countries are accepted for this remote job?