Reimbursement Specialist – Home Health Exp Preferred

Job Description:

• Investigate insurance benefits for new referrals
• Assign and pursue collections with a variety of payers
• Request authorizations and submit claims
• Interpret patient insurance, prescription, and other health-related documentation
• Conduct medical insurance verifications and investigations for commercial and government payors
• Communicate with insurance companies, patients, providers, and prescribers to coordinate reimbursement and access solutions
• Review unpaid accounts, determine status, and take appropriate action to ensure payment
• Review claims for compliance and completeness before submission
• Research alternative funding options to reduce patients’ financial burden
• Handle high call volumes
• Coordinate care with internal and external departments
• Maintain confidentiality of sensitive information
• Maintain regular, predictable, consistent attendance and flexibility to meet department needs
• Follow applicable regulations, policies, procedures, and standards
• Participate in continuous quality improvement
• Perform other duties as assigned

Requirements:

• High school diploma or equivalent is required
• Undergraduate degree is preferred
• 5 years of healthcare collections/billing experience preferred
• Strong understanding of hospice billing regulations (Medicare, Medicaid, commercial)
• Ability to read and interpret EOBs, remittances, and denial codes
• Effective payer follow-up and escalation strategies
• Ability to resolve claim holds, rejections, and denials
• Ability to identify trends in denials or delays
• Root-cause analysis to prevent recurring issues
• High attention to detail to ensure clean claims
• Ability to work AR reports and aging summaries accurately
• Clear, professional communication with internal teams and payer representatives
• Ability to explain payer issues in plain, understandable language
• Quick and accurate alphanumeric data entry skills
• Computer proficiency; MS Office and web-enabled applications strongly preferred
• Customer service skills required
• Ability to plan and organize work effectively and ensure completion
• Ability to meet productivity requirements
• Self-starter with exceptional organizational and follow-through skills
• Ability to work independently and in a team environment
• Must follow Medicare, Medicaid, and HIPAA regulations and requirements

Benefits:

• Medical, Dental and Vision Benefits
• Continued Education
• PTO Plan
• Retirement Planning
• Life Insurance
• Employee discounts
• Remote work schedule