Reimbursement Specialist Position Available In Orange, Florida
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Job Description
Reimbursement Specialist 100% REMOTE – must reside in
IN, OH, KY, TX, FL, MI, or IL Monday-Friday:
start time between 7am-8:30am then will work 8 hours (eastern time zone)
Job Description:
The primary purpose of this role is to jump in and help with denials within the commercial lines of insurance. Responsible for managing all aspects of accounts receivables to ensure maximum and timely reimbursement for hospital billing and claims. This role requires staying current on payer-specific regulations and procedures and providing written summaries of findings and recommendations. This is a customer-focused position with a strong emphasis on accounts receivable management. The representative will follow established guidelines to recover delinquent accounts, place calls to payers, and assist in maintaining Network A/R days. Follow-up may also be conducted via payer websites. Remote work flexibility is available after the initial training period.
Responsibilities:
Adhere to all network and departmental procedures and policies Comply with applicable state/federal laws and accreditation requirements Document all account actions clearly and accurately Maintain patient confidentiality Resolve denials and insurance correspondence within specified timeframes Follow billing and collection procedures, providing necessary information to adjudicate claims Meet A/R, productivity, and QA standards set by the department Monitor billing and follow-up holds to ensure timely resolution Participate in monthly payer conference calls
Must-Have Qualifications:
2+ years of medical billing experience, specifically handling denials with commercial payers (e.g., Anthem, Cigna, UHG, Humana, Aetna) Experience with government plans (Medicare, Medicaid, Tricare, HIP Plans) Strong understanding of reimbursement methodologies and contract pricing logic
Nice-to-Have Qualifications:
Candidates with only government plan experience will be considered Experience with EPIC is highly desirable
