Full-Time Reimbursement Specialist II - Prior Authorization

As a Reimbursement Specialist II – Prior Authorization, you are a seasoned expert within the revenue cycle team, driving impact through deep knowledge of insurance processes, payer policy, and prior authorization strategy.

You play a key role in ensuring patients receive timely access to care while maximizing reimbursement outcomes for the organization.

You will independently manage the full prior authorization lifecycle—navigating complex payer policies, securing timely approvals, and resolving escalated reimbursement issues.

With your extensive background in healthcare billing and payer engagement, you will lead efforts to streamline processes, troubleshoot complex denials, and collaborate with team members and ordering physician offices to ensure seamless communication.

You will be responsible for managing documentation for appropriate payer communication, handling correspondence, and conducting insurance claim research.

You will contribute to the development and implementation of training programs.

In collaboration with Finance, Client Services, Account Managers, and our billing technology partners, you will champion best practices and contribute to a high-functioning, compliant billing operation.

You’ll help build and maintain comprehensive documentation of payer requirements and support process improvement initiatives that increase efficiency and effectiveness across the department.

Minimum Qualifications:

• 5+ years of healthcare reimbursement experience, with a strong focus on prior authorization, insurance coordination, and payer relations.
• Expert-level knowledge of Medicare, Medicaid, and commercial payer authorization policies and appeals processes.
• Demonstrated success in managing complex, high-priority claims, including overturning denials through advanced appeal strategies and external reviews.
• Proficiency with revenue cycle tools and systems such as Xifin, payer portals, EDI enrollment, and merchant/payment solutions.
• Advanced Excel capabilities, including use of pivot tables, conditional logic, and trend analysis for reporting and decision-making.
• Proven track record of working cross-functionally with internal teams and external stakeholders to resolve reimbursement challenges.
• Strong written and verbal communication skills, with an ability to distill complex issues for both technical and non-technical audiences.
• Detail-oriented, self-motivated, and driven to identify process improvements that enhance operational performance.
• Experience with laboratory billing workflows and national/regional payer requirements is highly desirable.

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