Reimbursement Specialist

Philips•Chicago, IL

22h•$26 - $41•Hybrid

About The Position

Join a fast-paced revenue cycle team where you’ll take the lead in resolving complex insurance claims, driving timely reimbursements, and making a direct impact on financial performance and operational success. Your role: Manage denied and rejected insurance claims by researching root causes, correcting claim issues, and following up with payers to secure timely reimbursement. Review EOBs, payment variances, aging reports, and negative balances to ensure accurate claim processing. Work directly with insurance payers to resolve denials, authorization issues, filing errors, and reimbursement discrepancies. Escalate recurring payer trends and recommend process improvements or solutions to leadership. Verify patient eligibility and benefits, including qualifying diagnoses, prior testing, and authorization requirements. Interpret insurance benefits and claim outcomes to support accurate billing and reimbursement. Utilize Excel, dashboards, and daily/weekly worklists to track claims activity, monitor productivity, and identify reimbursement trends. Maintain compliance with internal processes, reimbursement standards, and quality expectations. Support team collaboration by assisting with payer resolution efforts across accounts and ensuring timely follow-up on insurance correspondence and outstanding claims.

Requirements

2+ years of experience in Accounts Receivable Management, Reimbursement, Collections, or Denial Management, with hands-on experience resolving denied and rejected insurance claims and working directly with payers.
Strong denial management and claims troubleshooting abilities
Knowledge of insurance payers, including Medicare, Medicaid, Blue Cross Blue Shield and commercial plans.
Proficiency in Excel, dashboards, and analyzing payer trends/worklists
Ability to verify insurance benefits and interpret EOBs (Explanation of Benefits)
Strong computer skills with the ability to navigate multiple systems efficiently
Bachelor’s degree, High School Diploma or GED, or vocational training in finance, accounting, business administration, economics, or a related field.
Analytical and detail-oriented professional with strong problem-solving and communication skills, who thrives working independently in a fast-paced environment while maintaining a collaborative and adaptable team-focused mindset.

Responsibilities

Manage denied and rejected insurance claims by researching root causes, correcting claim issues, and following up with payers to secure timely reimbursement.
Review EOBs, payment variances, aging reports, and negative balances to ensure accurate claim processing.
Work directly with insurance payers to resolve denials, authorization issues, filing errors, and reimbursement discrepancies.
Escalate recurring payer trends and recommend process improvements or solutions to leadership.
Verify patient eligibility and benefits, including qualifying diagnoses, prior testing, and authorization requirements.
Interpret insurance benefits and claim outcomes to support accurate billing and reimbursement.
Utilize Excel, dashboards, and daily/weekly worklists to track claims activity, monitor productivity, and identify reimbursement trends.
Maintain compliance with internal processes, reimbursement standards, and quality expectations.
Support team collaboration by assisting with payer resolution efforts across accounts and ensuring timely follow-up on insurance correspondence and outstanding claims.