Medical Reimbursement Specialist Job at Robert Half (South Weymouth)

Medical Reimbursement Specialist

We are looking for a skilled Medical Reimbursement Specialist to join our team o...

Location

United States , South Weymouth

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in hospital billing and insurance reimbursement processes
Strong knowledge of Explanation of Benefits (EOB) and medical payment posting
Proficiency in analyzing financial data and preparing reports
Familiarity with systems such as Experian and Strata for data extraction and analysis
Ability to research and explain financial variances in revenue and charges
Experience with preparing journal entries and conducting reconciliations
Excellent organizational and communication skills to collaborate effectively with cross-functional teams
Knowledge of regulatory requirements and processes for third-party cost reporting

Job Responsibility

Analyze monthly revenue performance against budget and investigate variances related to reimbursement, volume, and charges
Prepare and post journal entries for contractual allowances in Accounts Receivable, ensuring accurate reconciliations
Collaborate with finance and departmental teams to develop and support the annual hospital budget
Assist in the creation of presentations for hospital leadership, providing insights into financial performance
Direct the preparation and filing of third-party cost reports and regulatory documentation
Support annual audits by preparing necessary financial data and ensuring compliance with audit standards
Extract and analyze data from systems such as Experian and Strata to assist in budgeting, forecasting, and productivity modeling
Identify opportunities to streamline processes and implement improvements to enhance operational efficiency
Maintain detailed records and reserves for contractual allowances to ensure financial accuracy

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Medical Reimbursement Specialist

A Reimbursement Specialist is responsible for the timely and accurate billing an...

Location

United States , New Berlin

Salary:

Not provided

Coloplast

Expiration Date

Until further notice

Requirements

Two years of medical billing and/or transferable healthcare experience
Exceptional customer focus and ability to work under tight deadlines
Demonstrated ability to review and process complex billing information and resolve discrepancies independently while coordinating effectively with team members and other departments.

Job Responsibility

Print and review invoices from the billing system to ensure completeness and accuracy in accordance with company, department, and insurance guidelines
Prepare invoices and patient insurance details for entry into claims filing software
Enter all required information into claims software to generate electronic, paper, or faxed claims
Prepare and submit secondary and tertiary claims as needed
Review accounts receivable and aging reports, taking appropriate action to keep accounts current
Contact insurance companies to verify claim status and provide any required documentation
Determine when claims must be forwarded to secondary or tertiary insurance
Review Medicare and commercial EOBs to confirm proper claim processing
Submit corrected claims or request refunds and write-offs as appropriate
Initiate contractual write-off requests and prepare and submit appeals when necessary

What we offer

Comprehensive medical, dental, and vision coverage for you and your family
Access to company-sponsored wellness programs and mental health resources
Paid leave for qualifying events, and generous parental leave for both birthing and non-birthing parents
Health Savings Account (HSA) with employer contributions
Competitive 401(k) with a dollar-for-dollar match up to 6% and immediate vesting, financial planning services, and corporate discounts
State-of-the-art facility, thoughtfully designed with sit-stand desks, large monitors, and premium onsite amenities, including a gym and golf simulator
Flexible work options, Generous PTO plan, 10 paid holidays, and summer hours
Ongoing learning and career growth opportunities through training, mentorship, and tuition reimbursement
Join a Top Workplace
Engage in team-building, volunteer events, and our sustainability initiatives.

Medical Coding Reimbursement Review Specialist

We are seeking an experienced and detail-oriented Medical Coding Reimbursement R...

Location

United States

Salary:

21.42 USD / Hour

MMC Group LP

Expiration Date

Until further notice

Requirements

Certified Medical Coder certification required through recognized organizations such as AAPC or AHIMA
CPC (Certified Professional Coder) preferred
CCS (Certified Coding Specialist) preferred
Strong inpatient coding experience required
3-5 years of medical coding and reimbursement review experience preferred
Experience with CPT codes, ICD-10-CM, and HCPCS coding systems required
Strong understanding of CPT modifiers and reimbursement impact required
Experience with retrospective coding reviews required
IDRE experience required
Must be able to explain the IDR process during the interview

Job Responsibility

Perform retrospective payment reimbursement reviews with a strong focus on inpatient coding
Analyze CPT codes, modifiers, and claim interactions to ensure accurate reimbursement determinations
Review and interpret Explanations of Benefits (EOBs), including recoupments, corrections, denials, and claim adjustments
Evaluate how CPT modifiers impact reimbursement and payment outcomes
Conduct coding reviews across multiple provider specialties with broad CPT code knowledge
Review medical claims for compliance with coding standards and reimbursement guidelines
Prepare clear, accurate, and final binding payment determination letters for clients and disputing parties
Support Independent Dispute Resolution (IDR) cases and demonstrate knowledge of the full IDR process
Maintain compliance with billing regulations, coding standards, and applicable healthcare laws
Manage multiple priorities effectively while meeting strict deadlines in a high-volume environment

What we offer

Medical, dental, and vision coverage
Life and disability insurance
Additional voluntary benefits

Fulltime

New

Bilingual Reimbursement Specialist

In this role, you are much more than an administrator—you are the crucial link t...

Location

Canada , Saint-Laurent

Salary:

53000.00 - 57000.00 USD / Year

Randstad

Expiration Date

September 07, 2026

Requirements

Fluent professional bilingualism in French and English (oral and written)
1+ years of experience in a high-volume customer service or call center environment
Background exposure to healthcare, insurance, casework, or a patient-facing environment is a significant asset
Exceptional multitasking and organizational skills
High proficiency navigating the Microsoft Office Suite (Outlook, Word, Excel, Teams)
Strong critical thinking skills
Post-secondary education or equivalent professional experience in a related discipline

Job Responsibility

Strategic Case & Funding Management: Orchestrate every moving part required to secure prescription drug coverage for patients, navigating public, private, and federal funding channels seamlessly
Stakeholder Alliance Coordination: Act as the central point of contact between insurance companies, physicians' offices, pharmacies, and healthcare professionals to accelerate approvals
Documentation & Financial Advocacy: Prepare and process complex coverage paperwork, including Special Authorization forms, and implement Financial Means Testing to maximize patient access options
High-Touch Empathetic Communication: Manage high-volume inbound inquiries and conduct structured outbound tracking calls with patients, family members, and medical teams according to protocol
Vigilant Safety & Risk Auditing: Evaluate clinical data accurately to minimize programmatic risk while taking full ownership of identifying and reporting Adverse Events (AEs) to designated compliance units

What we offer

True Remote Autonomy: Enjoy a 100% work-from-home setup with all the infrastructure needed to succeed from day one
Comprehensive Health Protection: Access robust, pro-rated medical, dental, and vision care packages tailored to safeguard you and your family
Holistic Wellness Ecosystem: Take advantage of premium physical, emotional, financial, and social wellness programs designed for modern balance
Family-Centric Framework: Benefit from specialized support structures including backup dependent care, paid parental/caregiver leave, and family-building assistance
Career Cultivation: Accelerate your professional path with custom training programs, proactive mentorship initiatives, and regular exposure to leading pharmaceutical technologies

Fulltime

Reimbursement Specialist

In this role you will perform Reimbursement Specialist duties for assigned terri...

Location

United States , Saint Paul

Salary:

49600.00 - 68200.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

3+ years of industry experience, preferably in health insurance and/or durable medical equipment
Third party payer experience strongly preferred
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment
Possess the ability to manage time and prioritize critical priorities
Proficiency in Microsoft Office Software
Experience with Total Information Management System (TIMS) a benefit

Job Responsibility

Perform verification of eligibility and benefits to determine coverage and payer requirements
Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims
Gather clinical documentation to support medical necessity for Cardiology products and assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met
Prepare and submit prior authorization requests to insurance companies including commercial payers as well as government payers including Medicare and Medicaid
Process authorization decisions from payers timely to streamline and drive revenue
Negotiate payment rates for letter of agreement to ensure maximum collection potential
Provide a superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, or any pertinent product information with patients and healthcare teams
Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
Educational assistance programs
Time-off benefits such as paid holidays, paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave
Commuting benefits

Fulltime

Reimbursement Specialist

In this role you will perform Reimbursement Specialist duties for assigned terri...

Location

United States , Saint Paul

Salary:

49600.00 - 68200.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

3+ years of industry experience, preferably in health insurance and/or durable medical equipment
Third party payer experience strongly preferred
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment
Possess the ability to manage time and prioritize critical priorities
Proficiency in Microsoft Office Software
Experience with Total Information Management System (TIMS) a benefit

Job Responsibility

Perform verification of eligibility and benefits to determine coverage and payer requirements
Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims
Gather clinical documentation to support medical necessity for Cardiology products and assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met
Prepare and submit prior authorization requests to insurance companies including commercial payers as well as government payers including Medicare and Medicaid
Process authorization decisions from payers timely to streamline and drive revenue
Negotiate payment rates for letter of agreement to ensure maximum collection potential
Provide a superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, or any pertinent product information with patients and healthcare teams
Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance

What we offer

medical and dental coverage start on day one
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts
educational assistance programs
time-off benefits such as paid holidays, paid time off ranging from 20 to 35 days based on length of service, family and medical leaves of absence, and paid parental leave
commuting benefits
Employee Discount Program
Employee Assistance Program (EAP)

Fulltime

Reimbursement Specialist

In this role you will perform Reimbursement Specialist duties for assigned terri...

Location

United States , Saint Paul

Salary:

49600.00 - 68200.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

3+ years of industry experience, preferably in health insurance and/or durable medical equipment
Third party payer experience strongly preferred
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment
Possess the ability to manage time and prioritize critical priorities
Proficiency in Microsoft Office Software
Experience with Total Information Management System (TIMS) a benefit

Job Responsibility

Perform verification of eligibility and benefits to determine coverage and payer requirements
Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims
Gather clinical documentation to support medical necessity for Cardiology products and assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met
Prepare and submit prior authorization requests to insurance companies including commercial payers as well as government payers including Medicare and Medicaid
Process authorization decisions from payers timely to streamline and drive revenue
Negotiate payment rates for letter of agreement to ensure maximum collection potential
Provide a superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, or any pertinent product information with patients and healthcare teams
Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

Coding Reimbursement Specialist III Revenue Cycle

Location

United States , Charlotte

Salary:

25.30 - 37.95 USD / Hour

Advocate Aurora Health

Expiration Date

Until further notice

Requirements

High School Diploma or GED required
Minimum of 2 years of coding experience required
CPC or equivalent coding credential required
Maintain coding certification (CPC, CCS, RHIT, RHIA)
Extensive knowledge of coding, medical terminology, anatomy, and physiology
Extensive knowledge of and the ability to apply the payer specific rules regarding coding, bundling, and adding appropriate modifiers

Job Responsibility

Subject matter expert in at least one specialty, e.g., oncology, gynecology, surgical coding (not including primary care procedures) and infusion coding including chemotherapy and infusions involving multiple drugs
Assigns CPT and ICD codes in cases of moderate to high complexity
Reads, interprets and assigns CPT codes from provider documentation, e.g., infusion record or operative report
Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered
Appends all modifiers
Ranks CPT codes when multiple codes apply
Assigns Evaluation and Management (E/M) codes
Performs reconciliation process to ensure all charges are captured
Processes automated or manually enters charges into applicable billing system
Researches and analyzes coding and payer specific issues

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Opportunity for annual increases based on performance
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions

Fulltime

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Medical Reimbursement Specialist

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