Reimbursement Specialist - Healthcare Appeals & Collections

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 processes.

- In-depth knowledge of third-party payers and insurance reimbursement requirements.

- Experience following up with insurance payers on outstanding, unpaid, or underpaid claims.

- Experience researching claim denials, determining appropriate next steps, correcting or resubmitting claims, and supporting or submitting appeals.

- Ability to identify underpayments based on contracted rates, fee schedules, and payer agreements.

- Familiarity with medical policies, clinical guidelines, and payer-specific requirements.

- Strong understanding of medical and healthcare billing terminology.

- Experience working with commercial insurance, Medicare, Medicaid, and Workers’ Compensation payers.

- Strong computer and database management skills, with the ability to efficiently navigate proprietary electronic systems.

- Excellent written and verbal communication skills across a wide range of healthcare and insurance stakeholders.

- Strong organizational skills, attention to detail, and effective task management.

- Ability to manage changing priorities while maintaining accuracy and productivity.

- Calm, objective, and professional approach when handling stressful or emotionally challenging situations.

- High level of accountability for following policies, procedures, compliance requirements, and work standards.

- Ability to learn new tools, technologies, processes, and innovative approaches quickly.

- Strong persistence and work focus when dealing with obstacles, setbacks, or complex and unfamiliar situations.

- Ability to make sound routine decisions while seeking guidance when additional support is needed.

- Flexibility to work across multiple U.S. time zones when business needs require it.

- Ability to work effectively in a remote professional environment with prolonged periods of computer and desk work.

Benefits:

- Hourly compensation of $32.00–$35.00 , based on experience, qualifications, and other job-related factors.

- Fully remote position within the United States.

- Comprehensive medical, vision, and dental benefits.

- Supportive and collaborative work environment.

- Professional opportunity to work across healthcare reimbursement, appeals, collections, and payer operations.

- Work environment focused on teamwork, compassion, and meaningful contributions to patient support.

- Flexible working hours to support activities across multiple time zones.

- Equal opportunity workplace committed to accessibility, inclusion, and belonging.

- Employment is subject to successful completion of a standard background check, including employment history and applicable advanced degree verification.

How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
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