Reimbursement Specialist - Healthcare

Location

United States

Posted

38 days ago

Salary

$32 - $35 / hour

Seniority

Senior

No structured requirement data.

Job Description

Reimbursement Specialist - Healthcare

PRO-spectus

Title: Reimbursement Specialist - Healthcare Location: US - Remote Job Description: We’re always looking for talented, passionate individuals to join our team! This posting is part of our ongoing search for exceptional candidates. We maintain a pipeline of qualified candidates for current and future openings. By applying, you’ll be considered for opportunities that align with your skills and experience. If you’re driven, collaborative, and ready to make an impact, we encourage you to submit your application today to be part of our talent community. The Reimbursement Specialist II ensures that healthcare providers and organizations are appropriately reimbursed for their services. They are responsible for verifying insurance coverage, submitting reimbursement claims, and communicating with insurance companies, patients, and healthcare providers. In addition, they must stay up to date with changes in insurance policies and regulations that may affect reimbursement procedures. Core Duties/Responsibilities: - Ensure timely collection of outstanding Accounts Receivable and resolution of billing/claims issues. - Research, evaluate, and interpret complex information relative to appeals, payor specific billing policies, and guidelines related to insurance. - Manage assigned accounts to ensure timely and appropriate actions are taken to ensure positive cash flow. - Required to stay up to date with changes in insurance policies and regulations that may affect reimbursement procedures which include commercial, Medicare, Medicaid and Workers Comp payers. - Identify any payments not made in accordance with contracted rates and fee schedules and properly escalate the incorrect payment to the payer. - Cross train to provide department coverage. - Varying clerical and light accounting work. - Additional duties may include data entry, record keeping, participating in projects, and other administrative support as needed. Skills / Requirements - Extensive experience with appeals, payor specific billing policies, and guidelines related to insurance and collection follow-up. - In-depth understanding of healthcare billing and coding processes. - Ability to understand and navigate complicated insurance policies and regulations. - Excellent written and verbal communication skills throughout a variety of stakeholders, including insurers, patients, and healthcare providers. - Strong organizational skills, attention to detail, and effective task management while responding productively to changing priorities. - Remains calm and objective in emotional or stressful situations. - Learns quickly and applies innovative methods, tools, and technology to the role. - High level of self-accountability for compliance with policies, procedures, and work requirements. - Seeks advice when unsure about choosing a course of action. - Makes solid routine decisions with coaching from others. - Learns about the key drivers of the organization’s business and uses those learns in the day-to-day work. - Maintains tenacity and work focus despite obstacles or setbacks and is comfortable dealing with first- time or unusual challenges. Education, Certifications and Experience: - Experience with payors and Clinical Guidelines or Medical Policy is preferred.  - Conversant with medical and billing terminology. - Expertise and knowledge of third-party payor. - Computer and database management skills to efficiently and effectively manage proprietary electronic systems. - Interpersonal and communication skills to effectively deal with a variety of people, including physicians, hospital leaders, nursing staff, patients, and family members. - High School Diploma with 5+ years’ healthcare experience or an Associate's Degree in a healthcare-related field with 3+ years’ experience. Physical Requirements: - As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee’s home address listed in their employment file. - Prolonged periods of sitting at a desk and working on a computer - Keyboarding - Speaking - Must be able to lift up to 15 pounds at times. - Flexibility of working hours to support activities across multiple Time Zones. Our PRO-spectus Culture Philosophy At PRO-spectus we have created a culture that is supportive, dedicated, and teamwork driven. We celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships. Our employees bring strength of mind and spirit to make the extraordinary happen every day. With humility and compassion at our core, PRO-spectus is proud of our relentless focus towards the higher purpose of improving the lives of patients we support. We recognize it takes a lot of people working together with a common goal to make spectacular happen, and we never forget that at the heart of our company are the people who make it work. PRO-spectus is an Equal Opportunity / Affirmative Action employer. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws. At PRO-spectus, we are deeply committed to pay transparency and equity. The salary range for this position is $32.00 - $35.00 an hour, based on experience and qualifications, with the final offer reflecting skills and other job-related factors. Beyond competitive pay, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance.

Related Job Pages

More Threat Intelligence Specialist Jobs

Maverick Payments logo

Payments Governance Specialist

Maverick Payments

Technology-driven payment processing. Monetize payments as a reseller using our white-labeled dashboard & API.

Full TimeRemoteTeam 51-200H1B Sponsor

Title: Payments Governance Specialist Location: Calabasas, CA Job Description:Exciting Opportunities at Maverick Payments! Join our fast-paced, growing company and further your career with Maverick Payments, where you can thrive, your ideas are valued, and your colleagues feel more like family than coworkers! About Us: Maverick Payments is a family-owned and privately held full-service payment provider. Located in Calabasas, California, Maverick has created innovative technology designed for sales organizations, such as ISO’s and ISV’s, looking to monetize payments by reselling our white-labeled payments stack. Our payment products include merchant acquiring services, a proprietary gateway, ACH processing, fraud & chargeback tools, analytics, and other value-add services. Maverick’s team includes underwriting, risk management, compliance & legal, technology & product development, on-boarding, customer support, information technology, and more. About the Position: Under the direction of Maverick’s Director, Governance & Policy, the Payments Governance Specialist is responsible for supporting day-to day Governance functions, including but not limited to third party risk management, internal risk assessment, policy and procedure oversight, and quality assurance. The position partners closely with internal stakeholders and external parties to strengthen controls, support audit preparedness, and promote a strong culture of compliance and operational resilience. - Support the design, execution, and continuous improvement of governance processes across payments, control activities, and partner oversight. - Perform third-party risk management activities, including due diligence, onboarding reviews, periodic risk assessments, issue tracking, and ongoing monitoring of vendors, program partners, and external service providers. - Evaluate control environments for third parties and internal stakeholders to ensure alignment with company policies, sponsor bank expectations, and applicable regulatory requirements. - Monitor changes in the regulatory and payments landscape, perform horizon scanning, and communicate emerging risks, regulatory developments, and industry expectations to internal stakeholders. - Support compliance efforts related to card payments, merchant processing, sponsor bank oversight, consumer protection expectations, and operational risk management. - Prepare materials, documentation, and responses for sponsor bank reviews, audits, exams, and oversight meetings. - Coordinate audit readiness activities, including evidence gathering, control mapping, remediation tracking, and follow-up on findings from sponsor bank, internal, and external audits. - Partner with Compliance, Risk, Legal, Operations, Product, and Relationship Management teams to ensure governance requirements are embedded in business processes and change initiatives. - Track governance issues, action plans, and remediation items to closure, escalating concerns where appropriate. - Assist in drafting and maintaining policies, procedures, standards, and governance reporting related to payments, partner oversight, and risk management. - Support recurring governance committees, dashboards, and reporting packages by consolidating metrics, issues, trends, and key decisions. - Support operational quality assurance for key risk functions. - Support specialized governance, compliance, and risk management projects as assigned by leadership. - Assist with the development and enhancement of governance reporting, key risk indicators, and management information packages. - Participate in process improvement initiatives designed to strengthen oversight, documentation quality, and control effectiveness. - Contribute to regulatory change management activities, including impact assessments and implementation tracking. - Other duties as assigned. Qualifications: - 4+ years of experience in payments, governance, compliance, risk management, audit, or a related function within financial services, banking, fintech, or payment processing. - Experience supporting sponsor bank oversight, partner reviews, audits, or regulatory examinations. - Familiarity with third-party risk management practices, regulatory change management, and control documentation - High School Diploma required, bachelor’s degree preferred. - Knowledge of card payment processes, sponsor bank oversight expectations, and regulatory compliance principles relevant to the acquiring and payment processing industry. - Ability to analyze, test, assess, and interpret information or data to identify risks and recommend practical solutions. - Strong written and verbal communication skills, including the ability to prepare clear summaries, reports, audit materials, and governance documentation. - Strong organization and project coordination skills, with the ability to manage multiple priorities and deadlines. - Proficiency in Microsoft Office products, with strong capabilities in Excel, Word, and PowerPoint. - Ability to adapt to changing regulatory requirements, business priorities, and operational needs. - Ability to work collaboratively across departments and with external third parties. - Demonstrates sound judgment, accountability, and attention to detail. - Understanding of emerging risks, technologies, and trends in the payments space What We Offer: - Competitive Salary, Bonuses and Incentives. - Comprehensive employer sponsored health, vision, and dental insurance programs. - Paid time off, Paid Sick and Paid Holidays. - 401K plan with up to a 3% matching contribution. - Commitment to Career Development and Advancement. - Employee Recognition Programs - Vibrant Office Culture, Team Building, Birthdays, Work Anniversaries, Snacks, and more! Pay Range: $92k to $110k/Annually This position will consider remote candidates in the following states: AZ, CA (outside Los Angeles), CO, FL, GA, ID, IN, KS, KY, MA, MD, ME, NC, NJ, NV, NY, OH, OR, PA, TN, TX, UT, VA, WA Maverick Payments is an Equal Opportunity Employer. Pay Transparency Notice: At Maverick Payments, we believe in openness, honesty, and empowering our candidates to make informed career choices. As part of our commitment to transparency, we disclose the salary range for our positions. These ranges reflect our dedication to fair compensation practices and recognize the value that each team member brings to our organization. The final salary offer will be based on factors such as your experience, skills, and qualifications. Non-Solicitation from Third Parties: Do not contact Maverick Payments about this position unless you are a job seeker and potential applicant for this position. Do not contact Maverick Payments about other services, products or commercial interests. Notice to Agency and Search Firm Representatives: Maverick Payments is not accepting unsolicited resumes from agencies and/or search firms for this or other job postings. Resumes submitted to any Maverick Payments employee by a third-party agency and/or search firm without a valid written and signed search agreement, will become the sole property of Maverick Payments. No fee will be paid if a candidate is hired for this position as a result of an unsolicited agency or search firm referral. Fair Chance Ordinance: Maverick will consider qualified applicants with criminal histories in a consistent manner with the Los Angeles Fair Chance Initiative for Hiring.

Arizona + 23 moreAll locations: Arizona | California | Colorado | Florida | Georgia | Idaho | Indiana | Kansas | Kentucky | Massachusetts | Maryland | Maine | North Carolina | New Jersey | Nevada | New York | Ohio | Oregon | Pennsylvania | Tennessee | Texas | Utah | Virginia | Washington
$92K - $110K / year
Full TimeRemoteTeam 501-1,000H1B Sponsor

Role Description PriorityChef is looking for a detail-obsessed Amazon Reimbursement Specialist to own end-to-end recovery of funds owed to Priority Chef by Amazon FBA. This includes: - Lost and damaged inventory - Customer returns - Warehouse discrepancies - Inbound shipment shortages - Fee errors You will work directly in Seller Central and our internal reporting tools to identify, file, and follow up on reimbursement cases every single day — not once a month. Responsibilities include: - Audit FBA inventory daily to identify discrepancies: lost units (inbound/outbound), warehouse damages, customer return failures, and fee corrections - Open, track, and escalate reimbursement cases in Amazon Seller Central across all claim types: CustomerReturn, Damaged_Warehouse, Lost_Warehouse, Lost_Inbound, Lost_Outbound, CustomerServiceIssue, ReturnAdjustment, FeeCorrection - Monitor case statuses and follow up aggressively until resolved — no case left stale - Reconcile units found (added back to inventory) against units reimbursed to avoid double-counting and ensure net recovery accuracy - Maintain a live reimbursement tracker by claim type, unit count, dollar amount, and case status - Produce weekly and monthly summary reports (by reason code and total recovery) for leadership review - Identify patterns in loss drivers and surface findings to the operations team to reduce future exposure Qualifications - 1+ years of hands-on Amazon Seller Central experience, with direct FBA reimbursement case management - Strong understanding of Amazon FBA inventory flow: receive, store, pick/pack, ship, return - Proficiency in Excel or Google Sheets (pivot tables, VLOOKUP/INDEX-MATCH, data reconciliation) - High attention to detail — you catch the $0.01 discrepancy and the 428-unit gap - Proactive communicator: you surface issues before they become problems - Ability to manage a high volume of open cases simultaneously without losing track Benefits - FULL TIME REMOTE Work - Required 4hr overlap hours with Bangkok Time (other 4 hrs flexible) - $1,000 per month - Paid leave and additional perks - Opportunities for continuous learning and growth, especially in e-commerce Recruitment Process - Aptitude and Personality Test - Excel Task - Screen Recorded Amazon Task - Video Interview with Operations Manager - Video Interview with CEO

CTT (UTC+8)
$1K / month
Antech Diagnostics logo

Education Specialist, Ultrasound

Antech Diagnostics

Antech Diagnostics is one of the largest commercial veterinary diagnostic laboratories in the United States. The company is known to have a fast-paced work atmosphere with team mem

Title: Field Education Specialist, Ultrasound Location: Remote - IL Full time Job requisition id R-230291 Job Description: We understand that the world we want tomorrow starts with how we do business today, and that’s why we’re inspired to make A Better World for Pets. Antech is comprised of a diverse team of individuals who are committed to each other’s growth and development. Our culture is centered on our guiding philosophy, The Five Principles: Quality, Responsibility, Mutuality, Efficiency and Freedom. Today Antech is driving the future of pet health as part of Mars Science & Diagnostics, a family-owned company focused on veterinary care Current Associates will need to apply through the internal career site. Please log into Workday and click on Menu or View All Apps, select the Jobs Hub app, then click the magnifying glass to Browse Jobs. Work Type: Field Based/ Remote The Target Pay Range for this position is $71,000 - $89,000 annually. At Antech, pay decisions are determined using factors such as relevant job-related skills, experience, education, training and budget. Job Purpose/Overview The role of the Field Education Specialist, Ultrasound is to enhance the customer education experience by providing a high level of customer service and educational opportunities on including but not limited to: post sale onsite installation and education through applications training and veterinary scanning techniques; attend industry wet labs, tradeshows and complete product demonstrations in collaboration with the Sales Team; Serve as a lab instructor at Sound’s Academy of Veterinary Imaging to supplement and enhance the didactic portion of introductory education courses through hands on training. This team of ultrasound educators provide an essential and comprehensive ultrasound education to Veterinarians, Veterinary Technicians and Sonographers who in turn implement learned techniques within their own practices. Essential Duties and Responsibilities - Schedule ultrasound applications training process with customer - Design onsite apps training specific to customer needs - Deliver comprehensive applications training for entry level Ultrasound products offered by Sound. - Drive communication with Account Manager and DR Field Applications Specialist pre and post training - Connect ultrasound equipment to customers PACS, HIS and Telemedicine services - Customize entry level Ultrasound products to suit customer needs (presets, annotations, measurements) - Instruct on basic ultrasound physics and scanning techniques (probe handling, scanning planes, image orientation) - Instruct on veterinary imaging techniques for completing an abdominal ultrasound exam - Discuss uses for ultrasound in patient evaluation and treatment plan - Instruct on basic measurements necessary for obtaining diagnostic information - Provide applications (knobology) training for entry level Ultrasound products offered by Sound. - Optimize entry level Ultrasound products to suit student needs in lab environment - Set up for and clean up following labs - Handle laboratory animals (walking, feeding, transporting) - Ongoing educational feedback, as need on advanced system uses - Manage required reports, expenses, travel arrangements, and clerical reporting of tasks - Perform other duties as assigned Education and Experience - RDMS/RVT/RCMS, LVT, licensure strongly encouraged - BS/BA degree in related field or equivalent experience - Abdominal and Cardiac veterinary sonographer - Comprehensive knowledge of entry level Sound Imaging Ultrasound systems - Ability to provide clear instructions in an educational format; written and didactic. - Must possess good interpersonal skills with a customer service-oriented attitude - Intermediate computer skills required, including but not limited to: - Knowledge of basic computer networks and components required - Knowledge of all Microsoft office applications required - Knowledge of Medical image/video formats and storage methods - Knowledge of video conferencing applications Knowledge, Skills and Abilities - Must have strong planning & organizational skills with good attention to detail - Ability to handle many tasks at once including heavy phone and email volume - Knowledge of veterinary anatomy and ultrasound uses in patient treatment and evaluation - Knowledge of ultrasound physics and ability to explain - Ability to follow through and resolve issues - Ability to work independently with minimal supervision - Previous veterinary medicine background preferred - Prior customer service, ultrasound applications, teaching/education experiences a plus Travel Will there be notable travel in this position? Yes Percent of time: 90% Working Conditions The associate is regularly required to apply manual dexterity, including hand/wrist flexibility, for computer keyboarding. The associate frequently is required to sit for extended periods of time, stand, walk, and reach with hands and arms. The associate is frequently required to hear and speak in order to use the telephone, make presentations and communicate with people in an office environment. The associate is occasionally required to sit and stoop, bend, kneel, or crouch. The associate must occasionally lift and/or move up to 15 pounds. About Antech Antech is a leader in veterinary diagnostics, driven by our passion for innovation that delivers better animal health outcomes. Our products and services span 90+ reference laboratories around the globe; in-house diagnostic laboratory instruments and consumables, including rapid assay diagnostic products and digital cytology services; local and cloud-based data services; practice information management software and related software and support; veterinary imaging and technology; veterinary professional education and training; and board-certified specialist support services. Benefits Antech offers an industry competitive benefits package and continues to invest in and evolve benefits programs that meet the health, wellness and financial needs of our associates. Benefits eligiblity is based on employment status. - Paid Time Off & Holidays - Medical, Dental, Vision (Multiple Plans Available) - Basic Life (Company Paid) & Supplemental Life - Short and Long Term Disability (Company Paid) - Flexible Spending Accounts/Health Savings Accounts - Paid Parental Leave - 401(k) with company match - Tuition/Continuing Education Reimbursement - Life Assistance Program - Pet Care Discounts Commitment to Equal Employer Opportunities We are proud to be an Equal Opportunity Employer - Veterans / Disabled. For a complete EEO statement, please see our Career page at Antech Careers. Note to Search Firms/Agencies Antech Diagnostics, Inc. and its subsidiaries and affiliates (Antech) do not compensate search firms for unsolicited assistance unless they have a written search agreement with Antech and the requisition is position-specific. Any resumes, curriculum vitae, and other unsolicited assistance from search firms that do not have a written search agreement or position-specific requisition submitted to any Associate of Antech will be deemed the sole property of Antech and no fee will be paid in the event the candidate is hired by Antech.

Colorado
$71K - $89K / year

Role Description The Ophthalmology physician is assigned to VISN 23 Virtual Eye Care Program and provides comprehensive eye care for patients with a subspecialization in retina who have illnesses within the scope of Ophthalmology. This includes comprehensive care such as screening ocular health examinations, provision of glasses, disease management and follow up eye care all rendered by the virtual clinic. The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. - This is a virtual care position that reports directly to the Clinical Director of Virtual Eye Care. - Responsible for patient care through the Virtual Eye Care program. - Must be comfortable and willing to practice comprehensive ophthalmology, in addition to retina. - Requires travel of up to one week per month to provide procedural care at a VISN 23 facility. Qualifications - United States Citizenship. - Degree of doctor of medicine or an equivalent degree resulting from a course of education in allopathic medicine or osteopathic medicine. - Current, full and unrestricted license to practice medicine or surgery in a State, Territory, or Commonwealth of the United States, or in the District of Columbia. - Residency Training: Physicians must have completed residency training, approved by the Secretary of Veterans Affairs. - Proficiency in spoken and written English. - Board Eligible/Board Certified in Ophthalmology. - Fellowship trained in Medical or Surgical Retina. Requirements - Prior experience in eye telehealth is preferred. - Experience in tele-ophthalmology and tele-retinal services beyond diabetic teleretinal screenings is highly preferred. - One (1) year of clinical experience. - Secondary degree such as MBA, MHA, MPH. Benefits - Competitive salary, annual performance bonus, regular salary increases. - 50-55 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year and possible 5 day paid absence for CME). - Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA. - Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement). - Possible $1,000 per year reimbursement for CME (must be full-time with board certification). - Free liability protection with tail coverage provided. - No Physician Employment Contract and no significant restriction on moonlighting. - Monday - Friday, 8:00am - 4:30pm CT. Compressed tour available. Physical Requirements - Mild lifting (10-15 lbs); mild carrying (10-15 lbs). - Walking (5 hours); standing (4 hours); sitting (6 hours). - Ability to perform rapid mental and muscular coordination simultaneously. - Near vision correctable at 13" to 16" Jaeger 1 to 4; far vision correctable in one eye to 20/20 and to 20/40 in the other. - Hearing (aid permitted); emotional/mental stability.

United States
$315K / year
Job Closed