reimbursement specialist

MPOWERHealth

<div><div>Role Summary:
 
Performs a variety of AR activities and related tasks in order to recognize the maximum reimbursement from each claim. This position will be responsible for navigating the electronic medical record (EMR) and billing systems to obtain/produce and transmit the records required by the applicable insurance carrier or third party. Demonstrates understanding of explanation of benefits (EOBs) and ability to digest and respond appropriately to denials and correspondence. Clear and concise notation/documentation is paramount to success in the role.</div><div>
</div><div>
Responsibilities:</div><ul><li>
Understand and comply with all governmental, regulatory, company billing/AR and compliance regulations/policies assigned by payers.</li><li>
Analyze EOBs and construct responses to insurance carriers based on claim adjudication.</li><li>
Follow up with payers and other appropriate parties to collect open balances in a timely manner and to ensure compliance with payer guidelines.</li><li>
Identify and report payer issues regarding rejection trends, denial trends, or change in payments. Communicate specific payer information to appropriate parties/departments.</li><li>
Address denials and zero payments to identify and provide any requested documentation required to process the claim or refer to billing for claim corrections.</li><li>
Follow up and complete tasks on pending accounts in a timely manner until account is settled.</li><li>
Use of office equipment and software applications to facilitate finalization of claim.</li></ul><div></div><div> 
Join MPOWERHealth as a Reimbursement Specialist &ndash; Where Your Skills Drive Healthcare Forward! 
 
Are you a natural problem-solver who thrives on turning challenges into opportunities? Do you enjoy collaborating with a passionate team and making a direct impact on healthcare providers' success? If so, your next great opportunity is here at MPOWERHealth!</div><div></div><div> 
Why Choose MPOWERHealth? 
For over a decade, MPOWERHealth has empowered independent musculoskeletal physicians with cutting-edge clinical services, back-office solutions, and advanced technology. We simplify the complex, anticipate challenges, and guide our clients toward a brighter future. With our innovative analytics and expert teams, we transform obstacles into opportunities.</div></div>

Reimbursement Specialist

OSO HOME CARE

<div>The Home Infusion Biller is responsible for managing reimbursement activities related to home infusion services. This includes researching and resolving claim rejections and denials, documenting all account actions, and ensuring timely follow-up with Medicare, Medi-Cal, Managed Medi-Cal, and commercial payers (HMO and PPO). The position may qualify for collection-based bonuses.
Monday to Friday 8 am - 4:30 pm.
Experience<ul><li>
Minimum of 2 years of medical billing or collections experience in Home Infusion.</li><li>
Experience with CPR+ (Mediware) and/or CareTend software is a plus.</li><li>
Must have a solid understanding of medical terminology and insurance laws/guidelines.</li></ul>
Skills<ul><li>
Proficient in medical billing and CMS reimbursement guidelines</li><li>
In-depth knowledge of insurance verification and eligibility (Medicare Parts A-D, Medi-Cal, commercial plans)</li><li>
Familiarity with ICD-10, HCPCS, and NDC coding</li><li>
Experience with prior authorization submissions and appeals</li><li>
Competent in Microsoft Office (Word, Excel, Outlook) and EMR platforms</li><li>
Excellent analytical, time management, and organizational skills</li><li>
Strong math skills with the ability to calculate using whole numbers, fractions, and decimals</li></ul>
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com</div>

Mercalis

<div>Overview:

**SHIFTS FOR THESE ROLES ARE (4)8A-5P, (4)9A-6P, (2) 10A-7P - ALL EST; ALL M-F.** 
Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris&trade; revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.<div></div><div> 
As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers. You will facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient&rsquo;s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer. The primary function is to provide unparalleled customer service to patients, caregivers and providers as a dedicated contact by coordinating resources, exchanging information and ensuring appropriate delivery of services. These services include handling the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need.</div>
Responsibilities:<div></div><div> 
<ul><li>
Reimbursement Case Managers may be regionally aligned and will serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions</li><li>
Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy</li><li>
Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers</li><li>
Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient</li><li>
Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals</li><li>
Evaluate program enrollment forms for data integrity</li><li>
Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures</li><li>
Follow program guidelines and escalate complex cases according to program policy, SOPs, Call Guides, and other program materials.</li><li>
Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities</li><li>Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)</li><li>Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers</li><li>
Maintain records in accordance with applicable standards and regulations to the programs/promotions</li><li>Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
</li><li>Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness</li><li>
Understand health and disease states of patients of the programs
</li><li>Maintains a high level of ethical conduct regarding confidentiality and privacy</li><li>
Help maintain team morale by consistently demonstrating positive attitude
</li><li>On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data</li><li>Ensure all SOPs are followed with consistency</li><li>Conducts miscellaneous tasks or projects as assigned Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events) &ndash; (specific to program/client requirements)
</li></ul></div> 
Qualifications:
<ul><li>Associate or Bachelor&rsquo;s degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment</li><li>
Ability to communicate effectively both orally and in writing</li><li>
Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience</li><li>
Excellent problem-solving and decision-making skills required</li><li>
Attention to detail and committed follow through in communication with patients, providers and internal stakeholders</li><li>
Strong organizational skills</li><li>
Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards</li><li>
Strong interpersonal skills, ability to work both independently and as part of a team,ability to jump in and help others as needed</li><li>
Empathetic listening skills in order to interact effectively with patients and providers</li><li>
Punctual, reliable with strong attendance record</li><li>
Proficient with Microsoft products</li></ul>
Physical Demands &amp; Work Environment<ul><li>
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.</li><li>
Although very minimal, flexibility to travel as needed is preferred.</li><li>
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.</li></ul> 
Why Work for Valeris?
We&rsquo;re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:<ul><li>
Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs</li><li>
Additional health support, including telehealth and Employee Assistance Program (EAP) services</li><li>
Company match on Health Savings Account contributions</li><li>
Free Basic Life and AD&amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000</li><li>
Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability</li><li>
401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting</li><li>
Paid Time Off (PTO) and Sick Leave to support work-life balance</li><li>
Team members receive nine paid holidays plus two floating holidays</li><li>
Opportunities for advancement in a company that supports personal and professional growth</li><li>
A challenging, stimulating work environment that encourages new ideas</li><li>
Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace</li><li>
A mission-driven, inclusive culture where your work makes a meaningful impact</li></ul> 
Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice. 
Our Commitment to Equal Opportunity<div>
At Valeris, we don&rsquo;t just accept difference &ndash; we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.</div></div>

Partners In Home Care

<div>Join a Mission-Driven Team Supporting Care That Happens at Home

Partners In Home Care has proudly served Western Montana since 1987 as a leading non-profit provider of Home Health, and Hospice. Behind every great patient experience is a strong billing team&mdash;and we&rsquo;re looking for a detail-oriented Claims Reimbursement Specialist to help ensure accurate, timely reimbursement for the care we provide. 


What We Offer:

We have a large variety of benefits and unique programs to help support our staff to maintain a happy, healthy work-life balance.
<ul><li>
Generous Paid Time Off</li><li>
Comprehensive Medical, Dental, &amp; Vision&mdash;Beginning the first of the month following your start date. No months of waiting!</li><li>
Supplemental Insurance, FSA, &amp; HSA Account Options</li><li>
 401k Retirement Plan with Company Match</li><li>
Company Paid Life Insurance</li><li>
Tuition Reimbursement</li><li>
Annual Training Budget for Personal Development</li><li>
Employee Assistance Program, Legal and ID Protection, Pet Insurance, Financial Wellness Program, and many more!</li></ul> 


Department: Billing 
Employment Type: Full-Time 
Schedule: Monday&ndash;Friday 


Job Summary

The Billing Specialist is responsible for electronic and manual billing, claims submission, and follow-up with insurance carriers for home care services. This role ensures claims are accurate, compliant, and resolved efficiently while providing responsive customer service to patients, payers, and internal teams. 


Key Responsibilities
<ul><li>
Generate and submit insurance claims using appropriate CPT/HCPCS codes, modifiers, and narratives</li><li>
Ensure correct contractual pricing is applied and balances are billed appropriately to secondary payers or patients</li><li>
Review and respond to billing errors, denials, and return-to-provider reports</li><li>
Communicate with internal departments to resolve missing or inaccurate documentation</li><li>
Provide billing follow-up and customer service to patients regarding account questions and resubmissions</li><li>
Track and respond to program requests, denials, and third-party inquiries</li><li>
Review collection worksheets and initiate appropriate follow-up or resubmission actions</li><li>
Assist with visit statistics, reconciliation of reports, and discharge/admission data</li><li>
Maintain accurate and organized client billing files</li><li>
Conduct insurance verifications as needed to resolve billing issues</li><li>
Perform other duties as assigned</li></ul>
Required:
<ul><li>
High school diploma or equivalent</li><li>
Minimum one year of experience in billing, reimbursement, collections, credit, or medical office work</li><li>
Familiarity with medical terminology</li><li>
Proficiency with computer-based data entry and office software</li><li>
Strong communication and customer service skills, including frequent phone interaction</li></ul>

Preferred:
<ul><li>
Experience in healthcare billing, home health, hospice, or medical billing</li><li>
Attention to detail and ability to manage multiple tasks efficiently</li></ul>
If you enjoy detailed work, problem‑solving, and supporting meaningful patient care behind the scenes, we&rsquo;d love to hear from you. Join Partners In Home Care and be part of a team that makes a difference every day. 


Partners In Home Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.</div>

Claims Reimbursement Specialist

Syneos Health Commercial Solutions

<div>Description
The Field Reimbursement Specialist (FRS) will be responsible for the management of defined accounts in a specified geographic region in the ophthalmic therapeutic area, specifically supporting our client&rsquo;s products.
The FRS will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and other collaboration partners. Responsibilities include ensuring understanding of reimbursement process, field reimbursement services, and patient support program. The Reimbursement Specialist will also work on patient-level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI).
Field Reimbursement Specialists manage daily activities that support appropriate patient reimbursement to our client&rsquo;s products in the provider offices and work as a liaison to other patient assistance and reimbursement support services offered by our clients. Activities include, but are not limited to:<ul><li>
Act as an extension of the product providing live one-on-one coverage support.</li><li>
Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.</li><li>
Reviewing patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges.</li><li>
Reviewing patient insurance benefit options.</li><li>
Identifying alternate funding/financial assistance programs.</li><li>
Coordinating with our client&rsquo;s patient support services programs representatives.</li><li>
Educating physician office staff on the use of our client&rsquo;s patient assistance and call center support services, including web‑based provider programs.</li><li>
Provide information on relevant reimbursement topics related to our client&rsquo;s products.</li><li>
Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.</li><li>
Provide office support in accurate coding and billing for the client&rsquo;s products.</li></ul>
Minimum Qualifications &amp; Education:<ul><li>
Bachelor&rsquo;s degree required</li><li>
Minimum two years&rsquo; of access and reimbursement, managed care, and/or billing and coding support experience</li><li>
Experience working with Buy and Bill products and a thorough understanding of the entire reimbursement process from script to injection required</li><li>
Ophthalmic, retina specialists and biosimilar experience preferred</li><li>
Experience establishing relationships within a practice by working closely to help remove reimbursement barriers to specialty products for their patients</li><li>
Knowledge of Centers of Medicare &amp; Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus</li><li>
Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus</li><li>
Ability to travel and cover large multistate geography territories, 50% travel required</li><li>
Excellent presentation and project management skills</li></ul>
The annual base salary for this position ranges from $155,000 to $160,000. The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. In addition, some positions may include eligibility to earn commissions/bonus based on company and / or individual performance.
At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn&rsquo;t align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities.
Why Syneos Health? Our ability to collaborate and problem-solve makes a difference in patients&rsquo; lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game-changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients Experience the thrill of knowing that your everyday efforts are contributing to improving patients&rsquo; lives around the world.
Work Here Matters Everywhere | How are you inspired to change lives?
Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled)
Syneos Health has a voluntary COVID-19 vaccination policy. We strongly encourage all employees to be fully vaccinated. Additionally, certain local governments or Syneos Health customers may have vaccine requirements that apply to some of our employees. These employees are required to submit proof of vaccination to Syneos Health and maintain compliance with these requirements.
 
At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position will include a competitive compensation package, Health benefits to include Medical, Dental and Vision, Company match 401k, flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos Health complies with all applicable federal, state, and municipal paid sick time requirements. 
400003488</div>

Field Reimbursement Specialist

Search 10000+ Reimbursement specialist jobs near you this March. New roles added regularly across leading industries. Apply today.

10000 reimbursement specialist jobs Near Me

Reimbursement Specialist

Reimbursement Specialist

Reimbursement Specialist

Claims Reimbursement Specialist

Field Reimbursement Specialist

Field Reimbursement Specialist

Field Reimbursement Specialist