Reimbursement Specialist

Company: Advanced Rx

Location: U.S.-based
Industry: Pharmaceutical Services / Physician Dispensing

Position Summary

Advanced Rx Management, a rapidly growing pharmaceutical services company headquartered in Sunrise, Florida, is seeking a results-driven Reimbursement Specialist to support our expanding national client base.

This role is responsible for managing the full revenue cycle for Workers’ Compensation and Personal Injury prescription claims, with direct accountability for reducing Accounts Receivable and driving timely, accurate reimbursement. This is not a task-based billing position — the selected candidate will own a defined book of business and be responsible for resolving claims efficiently, minimizing AR aging, identifying denial trends, and improving overall cash flow performance.

The ideal candidate is analytical, detail-oriented, and proactive, with the ability to think critically through complex billing issues, identify root causes of denials or underpayments, and strategically move accounts toward resolution. We are seeking a team-oriented professional who values accuracy, accountability, and excellence in execution, and who contributes meaningfully to improved reimbursement outcomes in a fast-paced, growth-focused environment.

Key Responsibilities

Manage the full billing and collections lifecycle for a defined book of Workers’ Compensation and Personal Injury prescription claims, with direct accountability for AR performance and aging metrics
Maintain and thoroughly work a minimum of 40+ patient accounts, ensuring consistent progress toward resolution
Review and prioritize aging reports daily to proactively reduce 60/90/120+ day AR and accelerate reimbursement
Analyze EOBs, notices of disallowance, state fee schedule variances, and payment discrepancies to identify root causes and independently execute the appropriate resolution strategy (corrected claim submission, appeal, adjuster outreach, escalation, or legal follow-up)
Track and resolve unpaid and underpaid claims to ensure accurate reimbursement in accordance with contractual terms and state fee schedules
Prepare and submit timely, comprehensive appeals with complete medical and billing documentation to support dispute resolution
Ensure claim accuracy through detailed review and correction of demographic information, insurance data, ICD-10 diagnoses, CPT coding, and billing modifiers as needed
Identify denial patterns and recurring payer issues; recommend and support process improvements to reduce repeat denials and strengthen revenue cycle performance
Maintain detailed, accurate account documentation to support compliance, reporting, and effective follow-up
Communicate professionally and persistently with insurance carriers, adjusters, attorneys, and internal clinical teams to drive timely account resolution
Meet or exceed defined KPIs related to:
AR reduction targets
Collection rate improvement
Appeal success rates
Productivity standards (accounts worked daily)
Quality and accuracy benchmarks
Support special projects and revenue cycle improvement initiatives aligned with company growth objectives

Qualifications

Minimum 2 years of medical billing and collections experience (preferred)
Workers’ Compensation billing experience strongly preferred
Strong knowledge of EOB interpretation, understand ICD-10 coding, and denial management
Proven experience with appeals and insurance carrier follow-up
Strong analytical and problem-solving skills
High attention to detail and ability to manage multiple accounts simultaneously
Excellent written and verbal communication skills
Proficient in Microsoft Excel
Ability to work independently in a fast-paced, growth-oriented environment

Ideal Candidate Profile

The successful candidate will demonstrate: