Reimbursement Specialist lll

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

Summary

We are seeking a highly skilled and analytical Reimbursement Specialist III to join our dynamic team. This role is essential for securing accurate, timely financial collections and maximizing revenue. You will act as a key link between third-party payers, insurance plans, and patients. The ideal candidate thrives with minimal supervision, excels at submitting complex claims and appeals, and confidently resolves complex billing discrepancies.

Schedule Details

Location: Laguna Hills, CA

Schedule: Monday to Friday, 8:00AM-5:00PM

Duties and Responsibilities

- Reviews patient inventory of assigned accounts.

- Collects on all open AR inventory to ensure reimbursements are received within 30-45 days of billed date.

- Work on all correspondences assigned before due dates.

- Correlating insurance coverage with services to be provided.

- Initiate Single Case Agreements (SCA) when claims are short paid.

- Preparation and review of insurance claims.

- Review payer contracts and fee schedules to verify that received payments match agreed rates.

- In-depth understanding of healthcare billing and coding processes.

- Navigate complicated insurance policies and regulations.

- Evaluates payments received to ensure that reimbursement received is accurate.

- Maintains a positive DSO on assigned account inventory.

- Provides the highest level of customer service in answering patient phone calls and resolve patients’ questions and/or billing issues, as well as communicate with doctors’ offices and their staff.

- Assists in account collections activities as needed.

- Ensures compliance with all payer rules, regulations along with company policies & procedures.

- Monitor patient account inventories and process all assigned correspondence before due dates.

- Additional duties and responsibilities in different areas of the department on an as-need basis or determined by management.

Required Qualifications

- Proven experience in healthcare collections, with a strong understanding of the collections process from A–Z.

- Ability to work independently with minimal training and quickly learn processes, priorities, and expectations.

- Strong mathematical, analytical, and logical problem-solving skills.

- Excellent attention to detail, organization, and time-management skills, with the ability to manage multiple priorities and meet tight deadlines.

- Fluent in reading, writing, and speaking English.

- Ability to collaborate effectively with pharmacy teams and cross-functional departments.

- Demonstrated commitment to accountability, integrity, collaboration, and service excellence.

- Positive, professional attitude with strong interpersonal and teamwork skills.

Preferred Qualifications

- Home Infusion or Specialty collections experience preferred.

- Experience with automated billing systems such as CPR+ and CareTend preferred.

AmeriPharma’s Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 25 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

EEO Statement

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.