Reimbursement Specialist – Healthcare Appeals, A/R & Payor Collections

🔥 18 hours ago

🇺🇸 United States – Remote

💵 $32 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📞 Collections

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PRO-spectus

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2008

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

PRO-spectus is a patient access solutions provider that assists pharmaceutical companies, medical device manufacturers, and diagnostic firms in overcoming barriers to patient access. Their team offers expertise in reimbursement support, policy strategy, and market access, leveraging innovative technology to simplify the complexities that impede patients from receiving the necessary products. Through proactive guidance and collaborative partnerships, PRO-spectus aims to optimize the patient access journey, ensuring better access to healthcare products.

📋 Description

• Ensure timely collection of outstanding Accounts Receivable and resolution of billing and claims issues • Research, evaluate, and interpret complex information related to appeals, payor-specific billing policies, and insurance guidelines • Manage assigned accounts and take timely, appropriate actions to ensure positive cash flow • Stay current with commercial, Medicare, Medicaid, and Workers’ Compensation insurance policies and regulations • Identify payments that do not comply with contracted rates and fee schedules and escalate incorrect payments to payers • Cross-train to provide department coverage • Perform clerical and light accounting work • Complete data entry, record keeping, project participation, and administrative support as needed

🎯 Requirements

• Extensive experience with appeals, payor-specific billing policies, and insurance collection follow-up • In-depth understanding of healthcare billing and coding processes • Ability to understand and navigate complicated insurance policies and regulations • Excellent written and verbal communication skills with insurers, patients, healthcare providers, physicians, hospital leaders, nursing staff, and family members • Strong organizational skills, attention to detail, and effective task management while responding to changing priorities • Experience with payors and Clinical Guidelines or Medical Policy preferred • Conversant with medical and billing terminology • Expertise and knowledge of third-party payors • Computer and database management skills for proprietary electronic systems • High School Diploma with 5+ years’ healthcare experience or an Associate's Degree in a healthcare-related field with 3+ years’ experience • Flexibility of working hours to support activities across multiple time zones • Must be able to lift up to 15 pounds at times

🏖️ Benefits

• Comprehensive and generous benefits package designed to support employee well-being and work-life balance • Remote-forward work arrangement • Teleworking from the employee’s home address

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