- Track, report, and resolve complex outstanding claims
- Troubleshoot Explanation of Benefits (EOBs) and identify reasons for claim denials or low payments
- Appeal non-covered or underpaid claims through external review channels
- Follow up on unpaid claims to ensure timely resolution
- Drive positive coverage determinations through external appeals
- Maintain accurate documentation of payer communications, correspondence, and insurance research
- Collaborate with the billing tool provider, finance, and client services teams to streamline billing operations and optimize reimbursement processes
Requirements
- 2+ years’ experience in a healthcare reimbursement role
- Solid understanding of health plan regulations, billing processes, and payer interactions
- Experience with appeals at state and external review levels (IRO/IRBs) is preferred
- Organized with strong attention to detail
- Self-starter capable of working independently with minimal supervision
- Tech-savvy and analytical, able to troubleshoot complex issues
- Excellent written and verbal communication skills, especially in challenging scenarios
- Moderate proficiency in Excel (sorting, filtering, basic calculations)
- Familiarity with laboratory billing, Xifin, EDI enrollment, payer portals, merchant solutions, and national/regional payers is a plus
- Ability to work PST hours
- Background screening including criminal history is required
- Ability to sit for extended periods of time
- May be required to lift routine office supplies and use office equipment
Demonstrates expertise in healthcare reimbursement processes, including claims tracking, appeals management, and payer interactions, while maintaining strong organizational skills and attention to detail.
Highest-signal resume keywords
- Healthcare Reimbursement Experience
- Claims Tracking and Resolution
- Appeals Management
- Payer Interactions
- Excel Proficiency
ATS Optimization Keywords
Hard Skills
- Claims Tracking
- Appeals Management
- Billing Processes
- EOB Troubleshooting
- Documentation Maintenance
- Insurance Research
- Analytical Skills
- Attention to Detail
- Independent Work
- Problem Solving
Soft Skills
- Excellent Communication Skills
- Organizational Skills
- Self-Starter
Industry Keywords
- Health Plan Regulations
- Payer Interactions
- Laboratory Billing
- External Review Channels
- National Payers
- Regional Payers
Tools & Technologies
- Xifin
- EDI Enrollment
- Payer Portals
- Billing Tool Provider
- Merchant Solutions
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Reimbursement Specialist II Arbeitgeber: Jobtailor
Als Front Office Supervisor in unserem dynamischen Team bieten wir Ihnen die Möglichkeit, in einem unterstützenden und freundlichen Arbeitsumfeld zu wachsen. Wir legen großen Wert auf die berufliche Entwicklung unserer Mitarbeiter und bieten regelmäßige Schulungen sowie die Chance, Verantwortung zu übernehmen. Unsere Lage ermöglicht es Ihnen, Teil einer lebendigen Gemeinschaft zu sein, während Sie gleichzeitig die Standards unseres Franchise-Partners einhalten und unseren Gästen einen unvergesslichen Aufenthalt bieten.
