Revenue Cycle Account Reimbursement Specialist

Job Description

Job Description

Revenue Cycle Account Reimbursement Specialist Position Overview

A growing healthcare organization is seeking an experienced Account Reimbursement Specialist II to support its revenue cycle operations. This position is responsible for resolving complex insurance claims, analyzing denial trends, submitting appeals and reconsiderations, and ensuring timely, accurate reimbursement.

The ideal candidate has strong medical billing knowledge, understands payer requirements, and is comfortable collaborating with clinical and revenue cycle teams to address issues affecting billing and collections.

M-F; 8a-5p Key Responsibilities

• Serve as a billing resource for assigned departments, answering questions related to payer requirements, denials, and patient accounts
• Follow up on unpaid and underpaid insurance claims to support timely collection
• Research claim issues and complete corrections, reconsiderations, and appeals
• Review and interpret explanations of benefits to ensure claims and payments are reconciled correctly
• Identify trends involving denials, underpayments, and overpayments
• Partner with coding, charge capture, insurance verification, and reimbursement teams to resolve billing issues
• Recommend process improvements that strengthen revenue cycle performance and reduce preventable denials
• Coordinate medical-record requests and process insurance and patient correspondence
• Communicate with patients and insurance payers to research and resolve payment-related inquiries
• Manage and resolve billing cases within AthenaHealth
• Collaborate with clinic managers and revenue cycle staff to improve procedures and workflows
• Participate in departmental workgroups and provide feedback regarding payer denials, system issues, and claims activity
• Perform additional responsibilities as assigned

Qualifications

• At least three years of complex claims follow-up experience within a physician practice, hospital, ambulatory surgery center, or centralized medical billing office
• Knowledge of commercial insurance, HMO/PPO plans, Medicare, Medicaid, and payer reimbursement guidelines
• Experience reviewing denials and preparing claim appeals and reconsiderations
• Ability to interpret payer explanations of benefits
• Working knowledge of medical terminology, ICD-10, and CPT codes
• Strong organizational and time-management skills
• Ability to meet established productivity and accuracy standards
• Excellent verbal communication and customer-service skills
• Proficiency with Microsoft Word and Excel
• AthenaHealth experience is preferred

Education

• High school diploma or equivalent required
• Associate degree in business, healthcare administration, or a related field is strongly preferred