Reimbursement Specialist III

We are seeking a highly skilled and analytical Reimbursement Specialist III to join our dynamic team. This senior-level role is essential for securing accurate, timely financial collections and maximizing our organization's revenue cycle efficiency. Actively serving as a key link between third-party payers, insurance plans, and patients, you will protect financial health while ensuring a smooth financial experience for those we serve. The ideal candidate thrives with minimal supervision, possesses a deep understanding of industry regulations, and excels at submitting complex claims and appeals.

Responsibilities

Review patient inventory of assigned accounts; Collect on all open AR inventory to ensure reimbursements are received within 30-45 days of billed date; Work on all correspondences assigned before due dates; Correlate insurance coverage with services to be provided; Initiate Single Case Agreements (SCA) when claims are short paid; Prepare and review insurance claims; Review payer contracts and fee schedules to verify that received payments match agreed rates; Apply in-depth understanding of healthcare billing and coding processes; Navigate complicated insurance policies and regulations; Evaluate payments received to ensure reimbursement is accurate; Maintain a positive DSO on assigned account inventory; Provide high-level customer service by answering patient phone calls, resolving patient questions and billing issues, and communicating with doctors' offices and their staff; Assist in account collections activities as needed; Ensure compliance with all payer rules, regulations, and company policies and procedures; Monitor patient account inventories and process all assigned correspondence before due dates; Perform additional duties in different areas of the department as needed or determined by management

Requirements

Proven experience in healthcare collections, with a strong understanding of the collections process from A–Z; Ability to work independently with minimal training and quickly learn processes, priorities, and expectations; Strong mathematical, analytical, and logical problem-solving skills; Excellent attention to detail, organization, and time-management skills, with the ability to manage multiple priorities and meet tight deadlines; Fluent in reading, writing, and speaking English; Ability to collaborate effectively with pharmacy teams and cross-functional departments; Demonstrated commitment to accountability, integrity, collaboration, and service excellence; Positive, professional attitude with strong interpersonal and teamwork skills

Nice to have

Home Infusion or Specialty collections experience; Experience with automated billing systems such as CPR+ and CareTend

Benefits

Full benefits package including medical, dental, vision, and life insurance; Great pay and general compensation structures; Employee assistance program for mental health, legal questions, financial counseling, etc.; Comprehensive PTO and sick leave options; 401k program; Plenty of opportunities for growth and advancement; Company sponsored outings and team-building events; Casual Fridays