Medical Reimbursement Specialist

Job Summary:Charter Oak Health Center is seeking an Medical Reimbursement Specialist to join our team. In this role, you will be responsiblefor managing and resolving outstanding insurance and patient accounts to ensure timely and accurate reimbursement. This role focuses on claim follow-up, denial resolution, payment posting review, and the identification of trends impacting revenue. The specialist works collaboratively with the ECW outsourcing company, coding and front-end staff, and payers to reduce accounts receivable days and improve cash flow.Essential Position DutiesPerform timely follow-up on unpaid claims with insurance companies, including commercial, Managed Medicare, Medicare, and Medicaid payersInvestigate and resolve claim denials, underpayments, and rejectionsReview Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) for accuracySubmit corrected claims, appeals, and supporting documentation as neededIdentify root causes of denials and communicate trends to leadership and relevant departmentsEnsure compliance with payer guidelines, contractual agreements, and regulatory requirementsWork assigned work queues (WQs) and prioritize accounts based on aging and dollar valueCollaborate with front-end and coding teams to correct eligibility, authorization, or coding issuesMonitor timely filing limits and ensure claims are processed within required deadlinesDocument all account activity clearly and accurately in the practice management system (e.g., eClinicalWorks)Assist with reconciliation of payments and resolution of credit balances when applicableParticipate in audits, process improvement initiatives, and team meetingsWorks with team members on special projects using Excel and communicates results effectively, while also completing other assigned tasks.Performs other job-related or miscellaneous duties as assigned by management.Comply with the agency’s Mission.Must maintain appropriate professionalism and attendanceProfessional Experience/Educational RequirementsEducationHigh school diploma or equivalent requiredAssociate or bachelor’s degree in healthcare administration, Revenue Cycle, or related a plus.ExperienceMinimum of 2–4 years of experience in healthcare accounts receivable, medical billing, and reimbursementExperience with FQHC (a plus), hospital, or physician practice billingExperience with denial follow-upKnowledge of basic medical coding and third-party operating procedures and practicesKnowledge of ERA’s/RA’s and EOBs.Knowledge, Skills, and AbilitiesStrong understanding of payer guidelines, including Medicare, Medicaid, and commercial insuranceKnowledge of CPT, ICD-10, and HCPCS coding principlesFamiliarity with denial management and appeals processesExperience with electronic health records (EHR) and billing systems (e.g., eClinicalWorks)Strong analytical and problem-solving skillsAbility to manage high-volume workloads and meet productivity standardsExcellent communication and organizational skillsDetail-oriented with a focus on accuracy and compliance #J-18808-Ljbffr Charter Oak Health Center Inc