Insurance Reimbursement Specialist

ROUND TABLE MEDICAL CONSULTANTS LLC•Houston, TX

11d•$19 - $24•Onsite

About The Position

The Insurance Reimbursement Specialist is responsible for the collection, follow-up, and appeals of insurance claims. Essential to this position is the ability to manage all insurance follow-up for maximum insurance reimbursement. To include outbound and inbound insurance carrier calls, reprocessing claims, drafting appeals, working denials, and resolving unpaid claims.

Requirements

High school diploma or GED required.
Minimum of three years of experience in medical insurance follow-up, collections, denial management, and reimbursement.
Knowledge of both in-network and out-of-network facility and professional claims.
Strong knowledge of claim status follow-up, denial resolution, corrected claims, reconsiderations, and appeals.
Ability to read, analyze, and interpret EOBs, ERAs, payer correspondence, denial codes, and reimbursement information.
Proven experience preparing and submitting appeals in a high-volume claims environment.
Experience working in a production-based environment and consistently meeting productivity, accuracy, and quality expectations.
Strong verbal and written communication skills.
Ability to clearly communicate claim issues, reimbursement discrepancies, and appeal requests to insurance representatives.
Excellent analytical, problem-solving, research, and negotiation skills.
Ability to prioritize assignments, manage multiple deadlines, and work independently with minimal supervision.
Positive attitude and demonstrated ability to collaborate effectively with team members and leadership.
Proficiency with Microsoft Windows, Excel, Word, payer portals, and other medical billing applications.
Ability and willingness to learn new software, payer systems, and reimbursement processes.
Typing speed of 45–60 words per minute preferred.

Nice To Haves

Experience working with commercial insurance carriers, including UHC, Cigna, Aetna, BCBS, Marketplace plans, workers’ compensation, and third-party liability claims, is preferred.
Knowledge of EPOWERDOC and Centricity is preferred.

Responsibilities

Work assigned claims accurately, efficiently, and within established departmental and corporate timeframes.
Understand and stay informed of changes to procedures, billing guidelines, and laws for specific insurance carriers or payers.
Research claim status, payment discrepancies, denials, coding or billing issues, authorization concerns, eligibility problems, and payer-specific requirements.
Actively follow up and collect on all claims, including resolution of any billing errors following established procedures.
Follow all departmental policies, standard operating procedures, compliance requirements, and leadership directives.
Protect patient information and comply with HIPAA and all organizational confidentiality requirements.
Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction, and attendance.
Perform other duties as assigned by department manager.