Reimbursement Specialist Job at Arcadia Home Care and Staffing

Medical Reimbursement Specialist

We are in search of a Medical Reimbursement Specialist to join our team. Station...

Location

United States , Princeton

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 3 years of experience in a similar role
Proficient in benefit functions
Demonstrated expertise in billing functions
Experience in claim administration
Familiarity with collection processes
Ability to handle and resolve medical denials
Comprehensive knowledge of Medicare

Job Responsibility

Analyze and categorize outstanding claims based on payer, denial reason, and claim value
Investigate and take corrective action on unpaid, denied, or underpaid claims
Collaborate with internal teams to obtain missing documentation and expedite claim resubmission
Evaluate common denial reasons and address them accordingly, such as coding errors, medical necessity, and prior authorization
Submit corrected claims and formal appeals as required
Communicate with insurance payers to resolve aged claims and escalate unresolved claims as necessary
Maintain comprehensive records of all payer interactions
Identify the root causes of denials and implement best practices to prevent future issues
Suggest changes to workflow to enhance claim submission accuracy and speed
Conduct training for in-house billing teams on claim recovery strategies

What we offer

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

Fulltime

Sr Specialist, Value Access & Policy

Location

South Korea , Seoul

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

Master Degree or minimum 5 years of experience in pharmaceutical/biotech industry (market access, medical and marketing)
Knowledge in Korea healthcare system and national reimbursement environment
Ability to approach challenges with creativity and adaptability
Fluency in oral and written English
Ability to work, lead and influence cross functional team within various departments
Ability to prioritize and manage to timelines
Ability to rapidly assimilate information
Strong interpersonal skills

Job Responsibility

Develop strategic pricing and reimbursement for existing and oncoming Amgen products and collaborate with related teams to develop reimbursement dossier, pharmacoeconomic study, budget impact analysis and stakeholders engagement plan
Identify and feedback market environment change to drive proactive strategies and work closely with marketing, sales, medical and finance to formulate pricing and reimbursement through planning new products
Develop annual strategic plans and projects that support the value proposition, marketing, and market access in South Korea
Develop and manage long-term working relationships with industry, government and academics
especially dedicated to government advocacy
To implement stakeholders engagement through scientific engagement plan
Familiar with health policy issues and participant industry meeting to maximize company business
Develop and delivers Korea data and evidence leading to value propositions to support Amgen Korea business
Leads and/or provide inputs to the pre & post-market regional HEOR studies and projects, including clinical and economic outcomes research, patient reported outcomes, health economics modeling (budget impact and cost effectiveness) & literature searches
Manages budget and other relevant resources and timelines on the HEOR and Access projects, Track, communicate, and produce deliverables as planned to relevant contacts externally and internally

Reimbursement Specialist

This role is responsible for ensuring the timely and accurate resolution of acco...

Location

United States , Coral Springs

Salary:

23.53 USD / Hour

Coloplast

Expiration Date

Until further notice

Requirements

High school diploma or equivalent
Minimum of 3 years’ experience in collections
At least 1 year of experience in healthcare billing, insurance verification, or government medical programs (DME experience preferred)
Strong knowledge of medical terminology and healthcare reimbursement processes
Proficiency in reading and interpreting claim rejections and EOBs (Explanation of Benefits)
Solid negotiation skills and proven track record in collections

Job Responsibility

Review, correct, and process claims for all payers, both electronically and manually
Investigate and resolve claim denials, making corrections as needed
Apply accurate contractual adjustments to resolve outstanding balances
Respond to billing inquiries from patients and insurance representatives professionally and promptly
Reconcile patient collections and deposits
Identify and report denial trends
propose solutions to reduce future denials
Process refund requests and ensure compliance with payer guidelines
Maintain accurate and detailed documentation within patient account
Process appeals, including online and paper submissions

What we offer

Comprehensive medical, dental, and vision insurance plans
Access to company sponsored wellness programs and mental health resources
Paid leave of absence for qualifying events
Generous paid parental leave for both birthing and non-birthing parents
Competitive 401(k) plan with company match that vest immediately
Financial planning services
Corporate discount programs for goods and services
Generous paid time off
Flexible work hours
Flexible work arrangement options

Fulltime

New

Reimbursement Specialist

The Reimbursement Specialist (Skilled Reimbursement/Hospice) will be responsible...

Location

United States , Frisco

Salary:

Not provided

Arcadia Home Care and Staffing - an Addus family company

Expiration Date

Until further notice

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 denial
Ability to identify trends in denials or delay
Root-cause analysis to prevent recurring issues
High attention to detail to ensure clean claims

Job Responsibility

Accurately interprets patient insurance, prescription and other health-related documentation
Conducts medical insurance verifications and investigations for commercial and government payors
Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
Reviews unpaid accounts to determine status and taking appropriate action to ensure payment
Reviews all claims for compliance and completeness for claims submissions
Researches available alternative funding options to reduce patient’s financial burden
Handles high call volumes
Communicates with internal and external departments to facilitate coordination of care
Maintains a high degree of confidentiality at all times due to access to sensitive information
Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department

What we offer

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

Fulltime

Nurse Case Manager

Make 'being the difference' your Career at Bayshore. Bayshore is looking for car...

Location

Canada , Quebec City

Salary:

Not provided

Bayshore HealthCare

Expiration Date

Until further notice

Requirements

Registered Nurse or Registered Practical Nurse (RN/RPN) License
Current registration/licensing with the provincial regulating body of residence
Experience in immunology considered an asset
Familiarity with PIPEDA and how it applies in a confidential patient environment
Understanding of provincial and private coverage criteria and how to navigate the Canadian Drug Coverage Landscape is considered an asset
Experience in identifying and reporting adverse events to health Canada and Medical Information
Strong strategic thinking and problem-solving skills
Ability to multi-task, prioritize and manage time effectively
Strong problem-solving skills and the ability to think under pressure
Excellent computer skills

Job Responsibility

Be a single point of contact for physicians
Work in collaboration with the Reimbursement Specialist to support patients throughout the entire patient support program journey
Drive positive customer and patient experience

What we offer

Competitive pay
Comprehensive company-sponsored benefits for you and your family
Paid sick days
Continuous learning
Access to healthcare experts
Wide variety of work options

Fulltime

Patient Access Administrator

The Patient Access Administrator aids in the efficiency and workflow of the Bene...

Location

United States , Minneapolis

Salary:

45000.00 - 60000.00 USD / Year

Coloplast

Expiration Date

Until further notice

Requirements

Basic level understanding of medical insurance
Strong verbal and written communication skills
Passionate about providing patients with access to care
Astute attention to detail
Ability to work on a team aiming for collective success
Ability to work independently and problem solve
Highschool diploma or equivalent required, bachelor’s degree preferred
Min 1 year in transferrable administrative or comparable role preferred

Job Responsibility

Protect confidential patient health information (PHI) at all stages of the verification of benefits process
Manage case creation
Make outbound calls as necessary
Help maintain Kerecis customer relationship management (CRM) system for accuracy
Manage the Reimbursement email inbox and answer general inquires
Support Patient Access Specialists to process cases
Complete administrative tasks within the Customer Operations Department as assigned
Maintain a high quality of work, facilitating the ability for more patients to receive access to treatment with Kerecis products through accurate and timely case creation
Other tasks and responsibilities as assigned

Fulltime

Insurance Billing Specialist

As an Insurance Billing Specialist, you’ll help families access the medical equi...

Location

United States

Salary:

65155.00 - 78227.00 USD / Year

Babylist

Expiration Date

Until further notice

Requirements

3+ years of direct experience in DME billing and insurance reimbursement, managing the full claim lifecycle from eligibility verification through appeals and collections
Confidently review EOBs, identify payment discrepancies, denials, and adjustments, and take appropriate follow-up actions with minimal oversight
Worked extensively in Brightree and NikoHealth or comparable billing platforms, and are comfortable navigating EMRs like Epic, Kareo, or AdvancedMD to document and track claim progress
Working understanding of CPT, HCPCS, ICD-10, and relevant DME billing regulations such as HIPAA, CMS, and ERISA, and apply them accurately in your daily work
Spot issues others miss, ensuring claims are submitted cleanly, documentation is complete, and no step in the process is overlooked—even at high volume
Explain complex billing issues clearly and professionally, whether you're resolving a patient inquiry, collaborating with internal teams, or working with payers to resolve a denial
Thrive in a contributor role that values mastery, precision, and process excellence
Open to using AI tools that improve workflow efficiency and accuracy, and willing to adapt as the team adopts new technologies that enhance billing operations

Job Responsibility

Verify insurance: Conduct timely and accurate eligibility checks and benefit investigations through payer portals and phone outreach to ensure claims are submitted correctly from the start
Submit and track: Enter and monitor DME claims across multiple platforms, troubleshoot billing issues, and proactively follow up to reduce denials and accelerate reimbursement
Review and resolve: Analyze explanation of benefits (EOBs) for errors, missing payments, or misapplied patient responsibility, then determine and execute the correct resolution path
Draft and submit: Write detailed, well-supported appeals that address denial reasons clearly and improve chances of successful claim recovery
Investigate and escalate: Work aging reports weekly to identify unpaid or incorrectly paid claims, collaborate with payers or escalate internally as needed to drive resolution
Communicate clearly: Provide clear and empathetic responses to patients with billing questions, helping them understand their benefits and out-of-pocket costs without confusion
Collaborate cross-functionally: Work with Billing teammates, Customer Experience, Fulfillment, and cross-functional partners to identify process gaps and improve billing operations end to end
Leverage AI: Use AI-enabled tools that assist with eligibility, claims validation, and documentation to improve efficiency while maintaining billing accuracy and compliance
Support families: Ensure timely access to medically necessary DME by reducing billing friction, shortening reimbursement cycles, and ensuring every claim is processed with care

What we offer

Competitive salary with equity and bonus opportunities
Company-paid medical, dental, and vision insurance
Retirement savings plan with company matching and flexible spending accounts
Generous paid parental leave and PTO
Remote work stipend to set up your office
Perks for physical, mental, and emotional health, parenting, childcare, and financial planning

Fulltime

New

Senior Specialty Account Specialist - Respiratory

This role will provide you the opportunity to lead key activities, career growth...

Location

United States , Reading

Salary:

Not provided

GSK

Expiration Date

Until further notice

Requirements

Bachelor’s degree
Ability to travel domestically as necessary, which in some territories may include overnight travel up to 30%
Valid driver’s license
Must be able and willing to drive or operate a vehicle – driving is an essential function of this role
Specialty Account Specialist (grade 8): 5+ years of pharmaceutical/medical device experience
Senior Specialty Account Specialist (grade 7): 12+ years of pharmaceutical/medical device experience

Job Responsibility

Provide Scientific Knowledge, Business Acumen, and Customer Engagement expertise to specialist customers in support of a GSK biologic product
To understand the reimbursement/distribution landscape for specialist customers and identify the appropriate resources to refer customers to appropriate resource for reimbursement and distribution choices, always working within GSK guidelines and values
Maintain knowledge and data, which are constantly changing, with respect to severe asthma therapeutic expertise
Provide product educational programs/in-services to customers
Work within Compliance guidelines and GSK values always
Develop strategies and tactics to generate sales
Develop and implement strategies specific to each customer within an account (i.e., Allergists, Pulmonologists, nurses, PAs, business/office managers)
Develop and maintain strong working relationships with Marketing, Payer Relations Managers (Market Access), Medical (MSLs), and other functions within GSK
Effectively manage allocated resources (i.e., financial)
Provide outstanding customer service by responding to our customers' requests, inquiries and needs

Fulltime

Reimbursement Specialist

Arcadia Home Care and Staffing - an Addus family company

Location:
United States , Frisco

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
January 13, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Reimbursement Specialist

Medical Reimbursement Specialist

Sr Specialist, Value Access & Policy

Reimbursement Specialist

Reimbursement Specialist

Nurse Case Manager

Patient Access Administrator

Insurance Billing Specialist

Senior Specialty Account Specialist - Respiratory

Reimbursement Specialist

Arcadia Home Care and Staffing - an Addus family company

Location:United States , Frisco

Category:Finance

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:January 13, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Reimbursement Specialist

Medical Reimbursement Specialist

Sr Specialist, Value Access & Policy

Reimbursement Specialist

Reimbursement Specialist

Nurse Case Manager

Patient Access Administrator

Insurance Billing Specialist

Senior Specialty Account Specialist - Respiratory

Location:
United States , Frisco

Category:
Finance

Contract Type:
Not provided

Job Posted:
January 13, 2026