Full-Time Reimbursement Specialist II - Follow Up & Appeals

As a Reimbursement Specialist II, Follow Up & Appeals, you will play a vital role in ensuring the financial success of our organization. Collaborating with our billing tool provider, finance, and client services teams, you will streamline billing operations, optimize reimbursement processes, and support the company's mission and values.

Essential Duties and Responsibilities:

• 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.

Requirements:

• 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.

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