Overview
A healthcare diagnostics organization is seeking a mid-level Reimbursement Specialist to join their team. This full-time, non-exempt position operates Monday through Friday from 8:30am to 5pm PST. The role is integral to ensuring accurate and timely reimbursement by managing the insurance billing lifecycle, including verifying patient insurance coverage, submitting claims, posting payments, performing accounts receivable follow-up, and handling appeals.
Responsibilities
- Research and monitor billing issues, trends, and potential risks
- Review claims for accuracy and ensure all pre-claim requirements are met
- Track claim statuses and generate reports, particularly using Excel
- Review denied or unpaid claims and take corrective actions such as resubmission or appeals with minimal guidance
- Provide administrative support including data entry, record keeping, and participation in projects
- Navigate payer portals and systems to check eligibility, prior authorization, claim, or appeal statuses
- Apply knowledge of payer guidelines and policies to daily decision-making
- Assist patients with navigating their financial responsibilities with compassion and accuracy
- Verify insurance and recipient benefits with Medicare, Medicaid, and private insurers
- Ensure accurate and timely completion of daily billing tasks
- Review and interpret explanation of benefits documents
Requirements
Education
- High school diploma or GED required
- Associate's or bachelor's degree in healthcare administration, business, or related field preferred
Experience and Skills
- Minimum 2 years of experience in medical billing, insurance claims, or revenue cycle operations
- Proficient with Microsoft Office, especially Word and Excel
- Experience using payer portals and claim tracking systems
- Familiarity with HIPAA compliance and healthcare privacy regulations
- Experience with CRM systems (e.g., Salesforce) and billing software (e.g., Epic, XiFin, Quadax)
- Strong work ethic, attention to detail, and ability to maintain focus on broader objectives
- Analytical, interpersonal, communication, organizational, numerical, and time management skills
- Ability to manage multiple projects and meet deadlines
- Enthusiastic with an entrepreneurial spirit
Preferred Qualifications
- Familiarity with ICD and HCPCS/CPT coding
- Knowledge of CMS 1500 claim form
- Understanding of Claim Adjustment Reason Codes (NUCC)
Compensation & Benefits
- Pay range: $25 to $30 USD per hour
- Final salary dependent on experience, skills, location, education, and other factors
- Eligible for discretionary bonuses, incentives, and restricted stock units
- Competitive compensation and benefits package
Location
- This is a remote position with working hours aligned to Pacific Standard Time (PST)
This role offers an opportunity to contribute to transformative cancer care by ensuring efficient reimbursement processes within a growing healthcare diagnostics environment.