Reimbursement Specialist - Healthcare Appeals & Collections

Reimbursement Specialist
- Healthcare Appeals & Collections

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Reimbursement Specialist
- Healthcare Appeals & Collections based in the United States.

As a Reimbursement Specialist II, you will help ensure healthcare providers and organizations receive accurate and timely reimbursement for services delivered. You will manage healthcare accounts receivable, investigate unpaid and underpaid claims, and drive effective collection and resolution strategies. The role requires strong knowledge of insurance policies, payer requirements, billing practices, and healthcare reimbursement processes. You will research complex appeals, interpret payer-specific guidelines, and identify discrepancies against contracted rates and fee schedules.

Working with insurers, patients, providers, and other stakeholders, you will help resolve issues while maintaining clear and professional communication. This remote position offers an opportunity to contribute to positive cash flow and efficient reimbursement operations within a collaborative healthcare environment. Success requires organization, persistence, sound judgment, and the ability to remain focused while managing changing priorities and complex cases.

Accountabilities:

As a Reimbursement Specialist II, you will manage assigned reimbursement and collections activities while ensuring claims, appeals, and payer issues are handled accurately and within appropriate timelines.

• Manage outstanding healthcare Accounts Receivable and pursue timely collection of unpaid balances.
• Research, evaluate, and resolve complex billing and claims issues.
• Investigate insurance appeals and interpret payer-specific billing policies, clinical guidelines, and reimbursement requirements.
• Manage assigned accounts and determine appropriate follow-up actions to support positive cash flow.
• Follow up with commercial, Medicare, Medicaid, and Workers' Compensation payers regarding unpaid or underpaid claims.
• Identify payments that do not align with contracted rates or fee schedules and appropriately escalate discrepancies to the payer.
• Research claim denials, determine next steps, and support or submit appeals as required.
• Review payer policies, medical policies, and clinical guidelines to determine appropriate reimbursement actions.
• Maintain accurate records, documentation, and account information within electronic systems and databases.
• Perform data entry, record keeping, light accounting activities, and other administrative duties as needed.
• Cross-train with colleagues to provide coverage and maintain continuity of departmental operations.
• Participate in department projects and process-improvement initiatives.
• Communicate professionally and effectively with insurance companies, healthcare providers, physicians, hospital leaders, nursing staff, patients, and family members.
• Adapt priorities and workflows as needed while maintaining accuracy, compliance, and productivity.
• Seek guidance when appropriate and exercise sound judgment when handling routine or unfamiliar reimbursement situations.

Requirements:

The ideal candidate brings substantial hands-on experience in healthcare reimbursement, accounts receivable, insurance collections, and appeals, combined with strong knowledge of payer requirements and healthcare billing practices.

• 5+ years of healthcare experience with a High School Diploma, or 3+ years of experience with an Associate's Degree in a healthcare-related field.
• Extensive experience handling healthcare appeals, payer-specific billing policies, insurance guidelines, and collection follow-up.
• Strong understanding of healthcare billing, reimbursement, and coding…