Job Description

Job Summary 

The Remote Medical Insurance Reimbursement Specialist is responsible for processing, reviewing, and verifying reimbursement claims to ensure accuracy, compliance, and timely resolution. This role involves analyzing account balances, identifying discrepancies, and applying appropriate transaction codes to facilitate accurate claims processing. The Reimbursement Specialist I collaborates with internal teams to support workflow efficiency, revenue integrity, and compliance with payer guidelines while maintaining productivity and accuracy standards. 

Essential Functions

Processes and verifies reimbursement claims, ensuring accuracy and compliance with payer guidelines and regulatory requirements. Reviews and resolves claim discrepancies, identifying incorrect payments, denials, or underpayments and taking appropriate action. Applies correct transaction codes to accounts, ensuring proper claim adjudication and reimbursement flow. Monitors and follows up on outstanding claims, ensuring timely resolution and payment collection. Collaborates with revenue cycle teams and payers to investigate claim denials and appeal decisions when necessary. Researches and interprets payer policies, ensuring adherence to reimbursement requirements and claim submission rules. Documents account actions accurately and thoroughly in the appropriate systems, maintaining compliance with department protocols. Identifies process improvement opportunities, contributing to increased efficiency and streamlined reimbursement workflows. Maintains strict confidentiality of patient and financial information, ensuring compliance with HIPAA and corporate policies. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

H.S. Diploma or GED required Associate Degree or coursework in Accounting, Finance, Healthcare Administration, or related field preferred 0-1 years of experience in medical billing, reimbursement, claims processing, or accounts receivable required Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred

Knowledge, Skills and Abilities

Strong knowledge of medical billing, reimbursement procedures, and payer guidelines. Familiarity with claim submission, denial management, and appeals processes. Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments. Proficiency in electronic health records (EHR), billing software, and reimbursement systems. Strong problem-solving and critical-thinking skills, ensuring accurate claims resolution. Effective communication and collaboration skills, working with payers, revenue cycle teams, and internal departments. Knowledge of HIPAA, compliance regulations, and healthcare reimbursement standards.