Reimbursement Specialist

Job Summary We are seeking a proactive and detail-oriented Reimbursement Specialist to join our healthcare team. In this vital role, you will be responsible for managing the reimbursement process for medical services, ensuring accurate and timely claims submissions, and optimizing revenue recovery. Your expertise will help streamline billing workflows, resolve claim denials, and support the overall financial health of our organization. If you thrive in a fast-paced environment and possess a passion for accurate medical coding and billing, this is an exciting opportunity to make a meaningful impact in patient care and organizational success. Duties Review and interpret medical records, including documentation related to DRG (Diagnosis-Related Group), CPT (Current Procedural Terminology) codes, ICD-9, ICD-10, and ICD coding systems to ensure proper billing accuracy. Prepare and submit claims using Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems, adhering to payer guidelines and regulations. Analyze claim denials and rejections, identify root causes, and implement corrective actions to facilitate successful reimbursements. Collaborate with healthcare providers to clarify documentation discrepancies or incomplete records that impact reimbursement. Monitor accounts receivable, follow up on outstanding claims, and perform collections on overdue payments through medical collection processes. Maintain comprehensive records of billing activities, claim submissions, adjustments, and correspondence with payers. Stay current with updates in medical billing regulations, coding standards such as

ICD-9/10

transition requirements, and payer policies to ensure compliance. Experience Proven experience in medical billing, coding, or reimbursement roles within a healthcare setting. Strong knowledge of DRG classifications, CPT coding procedures, ICD-9/10 coding systems, and medical terminology. Familiarity with EMR/EHR systems used for billing and documentation management. Experience working with insurance claims processing, medical records management, and collections. Familiar with payer portals such as Availity and Novologix. Excellent attention to detail with the ability to interpret complex medical documentation accurately. Effective communication skills for collaborating with healthcare providers and payers to resolve reimbursement issues. Prior experience with medical office operations is preferred but not required. Join us as a Reimbursement Specialist to play a crucial role in ensuring our organization's financial sustainability while supporting high-quality patient care through precise billing practices!

Pay:

$26.00 - $30.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Paid time off Referral program Vision insurance

Experience:

Pharmacy/IVIG/Home Infusion Billing:

1 year (Preferred)

Work Location:

In person