Full-Time Reimbursement Specialist II - Follow Up & Appeals

• Track, report, and resolve complex outstanding claims.
• Troubleshoot Explanation of Benefits (EOBs) and identify reasons for claim denials or low payments.
• Appeal non-covered or underpaid claims through external review channels.
• Follow up on unpaid claims to ensure timely resolution.
• Drive positive coverage determinations through external appeals.
• Maintain accurate documentation of payer communications, correspondence, and insurance research.

• 0-2 years’ experience in a healthcare reimbursement role
• Solid understanding of health plan regulations, billing processes, and payer interactions.
• Experience with appeals at state and external review levels (IRO/IRBs) is preferred.
• Organized with strong attention to detail
• Self-starter capable of working independently with minimal supervision
• Tech-savvy and analytical, able to troubleshoot complex issues
• Excellent written and verbal communication skills, especially in challenging scenarios
• Moderate proficiency in Excel (sorting, filtering, basic calculations)
• Familiarity with laboratory billing, Xifin, EDI enrollment, payer portals, merchant solutions, and national/regional payers is a plus.

What is the last date for applying to the job?

Which countries are accepted for this remote job?