Description

Position Summary

The Reimbursement Specialist (RS) is responsible for resolving outstanding insurance claims and ensuring timely and accurate reimbursement. This role requires in-depth knowledge of insurance billing, payor appeal processes, and denial management. This position is full time and remote, with level (Specialist or Senior Specialist) determined based on your experience.

What you'll be doing:

• Manage assigned accounts receivable (AR) by following up with insurance companies to secure expected reimbursement, including outbound calls, payor portal activity, and other follow-up methods.
• Process insurance appeals including submission, tracking, reporting and evaluation of outcomes to determine next steps and improve results.
• Research and respond to patient and payor inquiries related to billing issues, claim status, and updates.
• Ensure the accuracy, completeness, and integrity of billed claims.
• Identify and communicate payor trends, including researching, quantifying, and articulating operational and financial impact.
• Review, analyze and interpret explanation of benefits (EOBs).
• Provide administrative support as needed, including data entry, cash posting, customer service support.
• Maintain compliance with all applicable laws and regulations related to billing, collections, refunds, HIPAA, and PHI.
• Performs other duties as required.

Requirements

What you'll need:

Knowledge, Skills & Experience:

• 2+ years of experience within revenue cycle management; laboratory billing experience preferred but not required.

• Proficiency with laboratory billing platforms (e.g., Telcor, Quadax, XiFin) or similar clinical billing systems.
• Strong working knowledge of healthcare billing codes (CPT, ICD-10, HCPCS) and insurance practices.
• Excellent written and verbal communication skills.
• Ability to work independently while also collaborating effectively within a team environment.
• Demonstrated attention to detail and strong organizational skills.
• Knowledge of HIPAA and PHI concepts with the ability to maintain confidentiality.

Education, Certifications, and Licensures:

• High School diploma or general education degree required.
• Related coursework or education (e.g., billing certificate, associate's degree, or bachelor's degree) with a focus on billing or related field preferred.

Other

• This is a remote position.