Reimbursement Specialist

We are seeking a detail-oriented and proactive Reimbursements Specialist to support reimbursement operations and help ensure the accurate and timely processing of claims and payments. This individual will play an important role in navigating insurance requirements, resolving reimbursement challenges, and supporting customers throughout the reimbursement process.

The ideal candidate has a strong understanding of insurance, reimbursement procedures, and claims management, along with excellent communication, organizational, and problem-solving skills.

This position requires someone who can work independently, manage competing priorities, and provide exceptional service while maintaining accuracy and compliance with applicable policies and regulations.

Key Responsibilities

• Manage and support reimbursement processes, including insurance verification, benefits investigations, claims submissions, and payment follow-up.
• Review insurance policies and coverage requirements to determine eligibility, benefits, and applicable reimbursement guidelines.
• Assist with resolving claim denials, payment discrepancies, authorization issues, and other reimbursement-related challenges.
• Communicate with insurance providers, third-party administrators, and other relevant parties to obtain claim status updates and facilitate resolution.
• Identify reimbursement barriers and proactively develop solutions that support timely claim processing and payment.
• Maintain accurate and thorough documentation of reimbursement activities, customer interactions, claim statuses, and case resolutions.
• Monitor outstanding claims and follow up on pending payments, appeals, and requests for additional documentation.
• Assist customers in understanding insurance coverage, reimbursement requirements, and necessary documentation.
• Ensure all reimbursement activities are conducted in accordance with applicable regulations, payer guidelines, and internal procedures.
• Collaborate with internal departments to address reimbursement concerns and improve overall processes.
• Identify trends in claim denials and reimbursement challenges and communicate opportunities for process improvement.
• Perform additional administrative and operational duties as needed to support the reimbursement team.

Qualifications and Experience

• An associate's or bachelor's degree is preferred. Equivalent professional experience will be considered.
• Two or more years of experience in healthcare reimbursement, insurance claims, medical billing, patient access, or a related field is preferred.
• Working knowledge of insurance terminology, reimbursement processes, benefits verification, and claims management.
• Experience working with commercial insurance, Medicare, and Medicaid is preferred.
• Familiarity with claim denials, appeals, prior authorizations, and insurance payment processes.
• Proficiency with Microsoft Office applications, including Excel, Word, and Outlook.
• Experience with customer relationship management systems, billing platforms, or reimbursement software is preferred.

Skills and Competencies

• Strong attention to detail and commitment to accuracy.
• Excellent verbal and written communication skills.
• Strong analytical, organizational, and problem-solving abilities.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Professional and customer-focused approach to resolving sensitive or complex reimbursement matters.
• Ability to work independently while contributing effectively to a collaborative team.
• Demonstrated ability to handle confidential information with discretion.
• Adaptability and willingness to learn new systems, processes, and payer requirements.

What We Are Looking For We are looking for someone who is resourceful, service-oriented, and motivated to make a positive impact through effective reimbursement support. The successful candidate will bring a proactive mindset, a strong sense of accountability, and the ability to navigate complex insurance processes while delivering a high level of service to both internal and external stakeholders.