Reimbursement Specialist

Lingraphica•West Windsor, NJ

4d•$50,000 - $55,000•Remote

About The Position

The Reimbursement Specialist is responsible for managing the full reimbursement lifecycle, including claim preparation, submission, and account follow-up to ensure accurate and timely reimbursement. This role serves as the primary owner of assigned accounts receivable activities, and collaborates with internal teams to resolve billing issues, reduce outstanding balances, and maximize revenue collection.

Requirements

High School Diploma or equivalent
1–3 years of experience in medical reimbursement, DME, medical billing, or healthcare revenue cycle management
1-3 years of experience using medical billing or claims management software, such as TrueSight
1-3 years of experience using payer and/or clearinghouse portals, such as MyCGS or Inovalon
Strong attention to detail, organization, problem-solving, and follow-up skills
Strong written and verbal communication skills
Ability to effectively manage multiple and shifting priorities in a fast-paced environment
Ability and willingness to travel within the U.S. (including airline travel) up to 2 times per year for in-person team and all-company meetings with possible additional travel (approximately 2 times annually) for conferences and events as needed

Nice To Haves

Experience managing both billing and collections activities within the reimbursement lifecycle
Experience working with patient balances, payment plans, and electronic payment solutions
Proficiency with Microsoft Office applications, particularly Excel and Outlook
Familiarity with TrueSight and/or Inovalon
Experience working with confidential or protected health information in a healthcare environment
Knowledge of HIPAA and healthcare privacy requirements
Experience with DMEPOS reimbursement, particularly Medicare DMEPOS

Responsibilities

Review claims and billing documentation for accuracy and completeness prior to submission to ensure compliance with payer requirements and reimbursement guidelines
Submit claims through TrueSight, payer portals, and invoicing processes for insurance, reseller, alternate funding, and other non-traditional reimbursement channels
Monitor submitted claims and invoices to ensure timely processing, payment, and resolution of outstanding balances
Perform timely follow-up with insurance companies, patients, caregivers, resellers, and other external partners to resolve payment issues and facilitate reimbursement
Review, identify, and correct claim rejections, billing errors, and submission issues to support timely resubmission and payment
Investigate claim denials, underpayments, and outstanding balances to determine root causes and implement appropriate resolution strategies
Submit appeals and supporting documentation for denied or underpaid claims to maximize reimbursement
Manage patient financial responsibilities, including establishing payment plans, sending payment links, and coordinating payment resolution prior to shipment and case completion
Monitor and manage assigned Accounts Receivable to reduce aging balances and support departmental collection goals
Maintain accurate and timely documentation of all billing, collection, and account activity within applicable systems
Collaborate with internal teams to identify trends, resolve reimbursement barriers, and improve billing and collection processes
Maintain compliance with payer requirements, reimbursement regulations, and company policies
Maintain confidentiality and adhere to HIPAA standards when handling Protected Health Information (PHI)
Maintain current knowledge of payer requirements, billing processes, reimbursement guidelines, and industry regulations
May be required to perform other duties as assigned