Reimbursement Specialist lll

AmeriPharma•Laguna Hills, CA

2d•$33 - $36•Onsite

About The Position

We are seeking a highly skilled and analytical Reimbursement Specialist III to join our dynamic team. This role is essential for securing accurate, timely financial collections and maximizing revenue. You will act as a key link between third-party payers, insurance plans, and patients. The ideal candidate thrives with minimal supervision, excels at submitting complex claims and appeals, and confidently resolves complex billing discrepancies.

Requirements

Proven experience in healthcare collections, with a strong understanding of the collections process from A–Z.
Ability to work independently with minimal training and quickly learn processes, priorities, and expectations.
Strong mathematical, analytical, and logical problem-solving skills.
Excellent attention to detail, organization, and time-management skills, with the ability to manage multiple priorities and meet tight deadlines.
Fluent in reading, writing, and speaking English.
Ability to collaborate effectively with pharmacy teams and cross-functional departments.
Demonstrated commitment to accountability, integrity, collaboration, and service excellence.
Positive, professional attitude with strong interpersonal and teamwork skills.

Nice To Haves

Home Infusion or Specialty collections experience preferred.
Experience with automated billing systems such as CPR+ and CareTend preferred.

Responsibilities

Reviews patient inventory of assigned accounts.
Collects on all open AR inventory to ensure reimbursements are received within 30-45 days of billed date.
Work on all correspondences assigned before due dates.
Correlating insurance coverage with services to be provided.
Initiate Single Case Agreements (SCA) when claims are short paid.
Preparation and review of insurance claims.
Review payer contracts and fee schedules to verify that received payments match agreed rates.
In-depth understanding of healthcare billing and coding processes.
Navigate complicated insurance policies and regulations.
Evaluates payments received to ensure that reimbursement received is accurate.
Maintains a positive DSO on assigned account inventory.
Provides the highest level of customer service in answering patient phone calls and resolve patients’ questions and/or billing issues, as well as communicate with doctors’ offices and their staff.
Assists in account collections activities as needed.
Ensures compliance with all payer rules, regulations along with company policies & procedures.
Monitor patient account inventories and process all assigned correspondence before due dates.
Additional duties and responsibilities in different areas of the department on an as-need basis or determined by management.