NAVERIS logo
NAVERIS

Transformative Technologies for Early Cancer Detection.

Reimbursement Specialist – Appeals

Location

North Carolina + 1 moreAll locations: North Carolina | Massachusetts

Posted

11 hours ago

Salary

0

Seniority

Senior

Bachelor Degree4 yrs expEnglish

Job Description

Reimbursement Specialist – Appeals

NAVERIS

• Support post-submission reimbursement activities • Focus on denials management and appeals • Investigate denials, prepare and submit appeals • Follow up with payers to ensure timely and accurate reimbursement • Manage various denial types and prepare higher-level appeals • Review and interpret Explanation of Benefits (EOBs) • Contact insurance companies and utilize payer portals • Submit corrected claims and appeals in accordance with payer guidelines • Maintain accurate documentation of denials and appeals actions • Assist in developing payer-specific appeals workflows • Communicate with patients and providers regarding appeals related questions • Critically assess challenging situations and escalate when appropriate • Ensure compliance with billing regulations and company policies

Job Requirements

  • 4+ years of experience in reimbursement, denials management, or revenue cycle management
  • Bachelor’s degree or equivalent experience
  • Experience with Xifin, Quadax, or Telcor preferred
  • Strong understanding of medical benefit structures
  • Working knowledge of CPT, ICD-10, and HCPCS coding
  • Proven ability to analyze denials, identify root causes, and resolve issues effectively
  • Strong attention to detail, judgment, and follow-through
  • Excellent verbal and written communication skills with a customer service mindset
  • Strong troubleshooting, organizational, and time-management skills
  • Ability to adapt to changing business needs
  • Self-starter who can work independently

Benefits

  • Competitive compensation
  • Work/life balance
  • Remote work opportunities

Related Job Pages

More Reimbursement Specialist Jobs

Numotion logo

Reimbursement Specialist

Numotion

Numotion is a leading mobility and rehab equipment supplier headquartered in Brentwood, Tennessee. Committed to serving its customer's lifelong needs, Numotion

Title: Reimbursement Specialist Location: REMOTE, US Tracking Code 15584-128 Position Type Full-Time/Regular Job Description: improve the lives of people with disabilities. As North America's largest provider of mobility products and services, we deliver personalized solutions from manual and power wheelchairs to medical supplies and other assistive technologies that support health, independence, and everyday participation. We're committed to a workforce of diverse backgrounds and experiences and to an inclusive environment shaped by open dialogue, attentive listening, and tangible, ongoing action. JOB PURPOSE: The Reimbursement Specialist will work to achieve cost effective accounts receivables performance as measured by payments, aging of receivables, and reduced DSO. The Reimbursement Specialist will report and make recommendations to improve applicable aspects of collections and unapplied payments, as directed by the Manager/Director. Take an active role in constantly improving the process. Communicate regularly/openly with RBC Director and other management. KEY RESPONSIBILITIES: - Responsible for the collection's accounts receivable on major accounts. - Collaborate with Billing & Collections Coordinator regarding assigned account collection activity. - Create and distribute weekly/monthly reports in required format as directed by manager. - Recommend departmental education, training needs or process improvements related to reimbursement functions to Reimbursement Managers and RBC Director. - Analyze and document trends related to payer denials, underpayments, overpayments, fee schedule changes, and BCC workflow related to unapplied deposits and other billing and collections functions. - Prepare and respond to audits/appeals within the timeframes (as dictated by the payer). - Conduct required training, as needed. - Assist/conduct new hire onboarding for Billing and Collections Coordinators. - Communicate weekly tracking and progress on appeals/audits with management. - Utilize Numotion Leadership Principles to perform the job with integrity, compliance, and values consistent with Numotion's mission. - Adhere to employee or customer confidentiality and comply with Numotion's policies and federal regulations. - Always provide excellent customer service for all internal and external customers of the operations. Provide solutions for customer concerns and continually focus on customer service as our top priority. - The above duties and responsibilities are not an all-inclusive list but rather a general representation of the duties and responsibilities associated with this position. The duties and responsibilities will be subject to change based on organizational needs and/or as deemed necessary by management. REQUIRED QUALIFICATIONS, SKILLS, AND EXPERIENCE: - High School Diploma and/or GED. - Minimum of three (3) years' accounts receivable collections experience - Minimum three (3) years' experience within health care, durable medical equipment or related capacity. - Knowledge of MS Word, Excel, PowerPoint, and Outlook. PREFERRED COMPETENCIES AND QUALIFICATIONS: - Ability to define problems, collects data, establish facts, and draw valid conclusions. - Superior communication skills, both written and verbal, to effectively address all levels within the organization. PHYSICAL WORK REQUIREMENTS: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Frequent use of hands, wrists, fingers associated with computer equipment. - Must be able to lift up to 10 pounds. - Must be able to work overtime as needed. Regularly required to sit or stand, reach, bend, stoop and move about the office. At Numotion, we offer competitive compensation packages, including medical, dental and vision insurance, short-term and long-term disability, a 401k, and life insurance. Numotion is an equal opportunity employer. We strive for a workplace that reflects the communities we serve and do not tolerate discrimination against our employees, customers, and partners regardless of ethnicity, disability, gender identity, sexual orientation, religion, age, citizenship, marital or veteran status. Numotion is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

United States
Healix Infusion Therapy, LLC logo

REIMBURSEMENT SPECIALIST

Healix Infusion Therapy, LLC

Healix is the nation’s leader in providing physician office-based infusion services. Focused on patient and physician peace of mind for 35 years, we offer unparalleled capabilities for optimal patient care, comfort, compliance, and clinical outcomes in an outpatient setting. At Healix, we manage Office Infusion Centers on behalf of physicians, hospitals, and medical institutions, encouraging in-office treatment for optimal patient care. Our company is headquartered in Sugar Land, Texas, a suburb of Houston, where we have helped establish and manage hundreds of infusion centers nationwide. Studies show that the physician office infusion center setting provides significant site of care benefits for patients, communities, and payors, including superior clinical outcomes and lower cost of care. Overall patient satisfaction at Healix-managed infusion centers soars, with 98% of patients rating their care as excellent.

OtherRemoteTeam 2-10

Role Description Healix Infusion Therapy is seeking a Reimbursement Specialist to join our corporate business office team! This role is 100% remote. M-F 8:30am-5:30pm. Essential Duties and Responsibilities: - Reviews aging reports with management to prioritize aged and high dollar claim resolution. - Analyze, identify and communicate trends from aging report that indicate non-payment or slow reimbursement associated with specific payors, therapies, patient accounts and/or clients. - Receives, investigates and responds to inquiries from payors. - Responsible for the follow-up of designated accounts. - Follow up on denied and short paid claims and payment errors and make applicable corrections for proper adjudication and reimbursement. - Prepare and submit appeals to overturn payor denials. - Proactively seeks resolution to billing issues that may arise and communicate findings to management and billing team. - Review claim EOBs and correspondence to resolve denials of non-paid claims. - Create Ad hoc reports as needed and distribute to requesting party. - Special Projects as assigned. - Other duties as assigned. Core Duties and Responsibilities: - Interacts professionally with clients and fellow employees. - Cooperates with team members to accomplish departmental goals. - Accepts and incorporates changes or new ideas into daily work. - Provides service in a responsive, timely and accurate manner to both clients and fellow employees. - Understands and adheres to policies and procedures. - Arrives to work as scheduled and notifies supervisors in a timely manner of any absences. - Recognizes priorities and acts; makes productive use of time. - Strives to resolve problems and conflicts on his/her own initiative. - Attempts to create new ideas or new procedures working as part of a group or individually. - As a part of your job, you will receive protected health information. It is your duty to comply with HIPAA in using and disclosing that protected health information. - Ability to remain focused, productive and available during company business hours while working remotely. - Maintain and adhere to productivity standards by providing updates of daily tasks completed to management. Qualifications - Four-year college degree preferred. - Two to three years in electronic claims submission and medical collections. - Proficiency in MS Excel. - Experience in Infusion billing and collections strongly preferred. Company Description Healix is the nation’s leader in providing physician office-based infusion services. Focused on patient and physician peace of mind for 35 years, we offer unparalleled capabilities for optimal patient care, comfort, compliance, and clinical outcomes in an outpatient setting. At Healix, we manage Office Infusion Centers on behalf of physicians, hospitals, and medical institutions, encouraging in-office treatment for optimal patient care. Our company is headquartered in Sugar Land, Texas, a suburb of Houston, where we have helped establish and manage hundreds of infusion centers nationwide. Studies show that the physician office infusion center setting provides significant site of care benefits for patients, communities, and payors, including superior clinical outcomes and lower cost of care. Overall patient satisfaction at Healix-managed infusion centers soars, with 98% of patients rating their care as excellent. Equal Employment Opportunity We are an Equal Employment Opportunity employer committed to providing equal opportunity in all our employment practices, including selection, hiring, assignment, re-assignment, promotion, transfer, compensation, training, leave of absence, discipline, and termination. The Company prohibits discrimination, harassment, and retaliation in employment based on race; color; religion; national origin; sex; pregnancy, childbirth, or related medical conditions; age; disability or handicap; citizenship status; service member status; or any other category protected by federal, state, or local law.

United States
Numotion logo

Reimbursement Specialist

Numotion

Numotion is a leading mobility and rehab equipment supplier headquartered in Brentwood, Tennessee. Committed to serving its customer's lifelong needs, Numotion

Role Description The Reimbursement Specialist will work to achieve cost effective accounts receivables performance as measured by payments, aging of receivables, and reduced DSO. The Reimbursement Specialist will report and make recommendations to improve applicable aspects of collections and unapplied payments, as directed by the Manager/Director. Take an active role in constantly improving the process. Communicate regularly/openly with RBC Director and other management. Key Responsibilities - Responsible for the collection’s accounts receivable on major accounts. - Collaborates with Billing & Collections Coordinator regarding assigned account collection activity. - Create and distribute weekly/monthly reports in required format as directed. - Recommend departmental education, training needs or process improvements related to reimbursement functions to Reimbursement Managers and RBC Director. - Analyze and document trends related to payer denials, underpayments, overpayments, fee schedule changes, and BCC workflow related to unapplied deposits and other billing and collections. - Prepare and respond to audits/appeals within the timeframes (as dictated by the payer). - Conduct required training, as needed. - Assist/conduct new hire onboarding for Billing and Collections Coordinators. - Communicate weekly tracking and progress on appeals/audits with management. - Utilize Numotion Leadership Principles to perform job with integrity, compliance, and values consistent with Numotion’s mission. - Adhere to employee or customer confidentiality and comply with Numotion’s policies and federal regulations. - Always provide excellent customer service for all internal and external customers of the operations. Provide solutions for customer concerns and continually focus on customer service as our top priority. Qualifications - High School Diploma and/or GED. - Minimum of three (3) years’ accounts receivable collections experience. - Minimum three (3) years’ experience within health care, durable medical equipment or related capacity. - Knowledge of MS Word, Excel, PowerPoint. Preferred Competencies and Qualifications - Ability to define problems, collect data, establish facts, and draw valid conclusions. - Superior communication skills, both written and verbal, to effectively address all levels within the organization. Physical Work Requirements - Frequent use of hands, wrists, fingers associated with computer equipment. - Must be able to lift up to 10 pounds. - Must be able to work overtime as needed. - Regularly required to sit or stand, reach, bend, stoop and move about the workplace. Benefits - Competitive compensation packages, including medical, dental and vision insurance. - Short-term and long-term disability. - 401k. - Life insurance.

United States
The Cigna Group logo

Claim Negotiator - Non-Par Reimbursement

The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

OtherRemoteTeam 10,001+Since 1982H1B No Sponsor

Role Description The job profile for this position is Provider Relations Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. This role is an individual contributor within the Nonpar Provider Contracting Team, supporting our enterprise strategy to deliver affordable, predictable, and simple health care. The position is responsible for: - Negotiating nonpar single case agreements - Ensuring compliance - Fostering strong partnerships with internal and external stakeholders Summary of Responsibilities: - Skillfully navigate reimbursement conversations with nonpar health care professionals while providing exceptional service - Negotiate reimbursement rates for nonpar health care providers - Utilize excellent verbal and written communication skills - Partner with internal teams to resolve complaints and disputes - Ensure compliance with policies, procedures, and regulatory requirements - Suggest process improvements and foster innovation - Utilize knowledge of medical terminology and standard reimbursement methodologies - Manage multiple priorities in a fast-paced environment Key Duties and Responsibilities: - Review and prioritize daily work assignments for timely single case agreement negotiation - Develop individual case pricing strategies and present to management and/or providers - Accurately document case outcomes in all systems and communicate results to stakeholders - Serve as team subject matter expert (SME) for highly complex cases - Support department goals contributing to organizational success - Communicate and collaborate effectively with internal and external partners - Adhere to all Compliance/Program Integrity requirements and HIPAA regulations - Promote professional growth through continuing education and skills development Qualifications - Minimum 2+ years of experience in healthcare contracting, provider relations, or reimbursement negotiations required - Single case agreement or billing negotiation experience required - Demonstrated experience in interpreting and applying reimbursement methodologies - Proficiency in medical terminology and healthcare industry standards - Strong negotiation and conflict resolution skills - Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook) - Ability to manage multiple priorities in a high-volume environment Requirements - If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload Benefits - Comprehensive range of benefits, with a focus on supporting your whole health - Health-related benefits including medical, vision, dental, and well-being and behavioral health programs - 401(k) - Company paid life insurance - Tuition reimbursement - A minimum of 18 days of paid time off per year - Paid holidays and leaves of absence - Eligibility to participate in an annual bonus plan

United States
$58.1K - $96.9K / year