Reimbursement Specialist

Reimbursement Specialist

Stern Cardiovascular is seeking an experienced Reimbursement Specialist to resolve complex accounts receivable denials and unpaid or underpaid insurance claims. The ideal candidate has demonstrated expertise in denial management and claim adjudication across all major healthcare carriers, including Medicare, Medicaid, commercial insurers, and managed care plans. This role reviews payer requirements and remittance information, corrects claim issues, prepares appeals, and follows accounts through final resolution while maintaining accuracy, productivity, and compliance.

Key Responsibilities:

• Analyze denial root causes, claim adjudication results, remittance details, payer policies, and filing requirements.
• Correct claim errors and complete reconsiderations or appeals for denied, rejected, and underpaid claims.
• Manage assigned work queues, document account activity, and complete timely payer follow-up.
• Prioritize high-dollar and complex denials, escalate issues when needed, and drive claims to resolution.
• Identify denial trends and partner with clinical, coding, billing, and other internal teams to prevent recurring issues.
• Follow CMS, payer, privacy, and company compliance requirements.

Qualifications:

• High school diploma or GED required.
• Two years of medical billing, insurance follow-up, reimbursement, or denial-resolution experience preferred; equivalent education and directly related experience will be considered.
• Demonstrated expertise in denial management and claim adjudication with all major healthcare carriers, including Medicare, Medicaid, commercial insurers, and managed care plans.
• Ability to interpret explanations of benefits and electronic remittance advice, identify denial causes, correct claim errors, and prepare effective reconsiderations and appeals.
• Knowledge of medical terminology, healthcare reimbursement, payer policies, claim edits, CPT coding, and ICD-10-CM coding preferred.
• Strong analytical, problem-solving, communication, organization, and interpersonal skills.
• Ability to meet productivity and quality standards while maintaining accurate documentation and thorough follow-up.