Reimbursement Specialist

Reimbursement Specialist Liability

A well-established healthcare organization specializing in orthopedic and specialty medical services is looking for a Reimbursement Specialist. The team is dedicated to delivering exceptional patient care while maintaining efficient and accurate revenue cycle operations.

Job Description:

The Reimbursement Specialist is responsible for managing liability accounts receivable, including working with attorneys and insurance carriers to resolve claims efficiently. This role requires strong analytical skills, persistence in follow-ups, and the ability to clearly communicate billing information. The position offers a hybrid work arrangement with occasional in-office responsibilities.

Key Responsibilities:

• Respond to incoming calls from patients, attorneys, and insurance representatives, providing clear account guidance
• Track and follow up on outstanding liability claims to ensure timely payment
• Maintain thorough documentation of account activity for compliance and tracking purposes
• Review and reconcile account balances, ensuring accuracy based on fee schedules and agreements
• Compile and submit required documentation to support claim processing
• Investigate claim denials and coordinate appeals with appropriate supporting information
• Explain billing statements and insurance coverage details in a professional and understandable manner
• Communicate with insurance carriers to resolve unpaid or delayed claims
• Support additional tasks and projects as needed

Qualifications:

• Minimum of 3 years of primary liability accounts receivable or collections experience
• Experience working with major liability payors (e.g., auto insurance carriers)
• Strong understanding of revenue cycle processes, preferably within orthopedics or related specialties
• Knowledge of medical billing components such as procedures, modifiers, and claim requirements
• Experience negotiating with attorneys or legal representatives
• Familiarity with practice management systems (Athena experience preferred but not required)
• High school diploma or GED required

Additional Details:

• Onsite training required for approximately 23 weeks (based on individual progress)
• Hybrid role with occasional in-office requirements (approximately twice per month or as needed)
• Candidates must reside within a reasonable commuting distance to the office
• Dedicated work-from-home setup required
• Professional attire expected during onsite work

Perks:

• Flexible start times for improved work-life balance
• Hybrid work model with remote flexibility
• Opportunity to work in a fast-paced, collaborative environment
• Exposure to complex liability claims and advanced revenue cycle processes
• Career growth potential within a specialized healthcare setting

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.