Reimbursement Escalation Specialist

Philips • Plymouth, MN

14d • $34 - $55 • Onsite

About The Position

Reimbursement Escalation Specialist (Plymouth, MN) As a Reimbursement Escalation Specialist, you will drive resolution of high‑priority, complex payer issues that directly impact accounts receivable, claim aging, and cash collections. Your role: Escalate, track, and report reimbursement trends to the Revenue Cycle Management team on a daily, weekly, and monthly basis. Partner with insurance carriers to clarify claim issues and manage payer prepayment audits. Serve as a point of escalation for complex claims, addressing inquiries and requests from cross‑functional teams including Cash Application Specialists, Payer Relations, Patient Collections, and Reimbursement. Review and approve claims adjustment requests to validate all required collection actions have been completed in accordance with work instructions, while maintaining compliance with payer‑specific requirements for claims processing, appeals, credits, and refunds. Build strong working relationships with operations and collection teams to reduce claim payment turnaround time. Communicate with patients regarding outstanding balances, including establishing and approving payment plans as appropriate.

Requirements

• 4+ years of experience in medical claims billing or collections and 1+ years in a lead or supervisory role within Revenue Cycle Management.
• Knowledge of insurance payers, including Medicare, Medicaid, Blue Cross Blue Shield and commercial plans.
• Managing denials, claim appeals and claim recoupments.
• Knowledge of eligibility of benefits and authorizations.
• High school diploma or GED (required) or equivalent work experience or combination of secondary education and work experience
• Excellent communicator, both written and verbal.

Responsibilities

• Escalate, track, and report reimbursement trends to the Revenue Cycle Management team on a daily, weekly, and monthly basis.
• Partner with insurance carriers to clarify claim issues and manage payer prepayment audits.
• Serve as a point of escalation for complex claims, addressing inquiries and requests from cross‑functional teams including Cash Application Specialists, Payer Relations, Patient Collections, and Reimbursement.
• Review and approve claims adjustment requests to validate all required collection actions have been completed in accordance with work instructions, while maintaining compliance with payer‑specific requirements for claims processing, appeals, credits, and refunds.
• Build strong working relationships with operations and collection teams to reduce claim payment turnaround time.
• Communicate with patients regarding outstanding balances, including establishing and approving payment plans as appropriate.

Benefits

• Employees are eligible to participate in our comprehensive Philips Total Rewards benefits program, which includes a generous PTO, 401k (up to 7% match), HSA (with company contribution), stock purchase plan, education reimbursement and much more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED