Reimbursement Specialist

California Specialty Pharmacy,LLC•Visalia, CA

10h

About The Position

The Reimbursement Specialist plays a critical role in ensuring that healthcare providers receive accurate and timely payments for services rendered. This position involves managing the entire reimbursement process, including claim submission, follow-up, and resolution of payment discrepancies. The specialist will work closely with insurance companies, patients, and internal departments to verify coverage, resolve denials, and optimize revenue cycles. By maintaining up-to-date knowledge of payer policies and healthcare regulations, the Reimbursement Specialist helps to minimize financial losses and improve cash flow. Ultimately, this role supports the financial health of the organization by ensuring compliance and maximizing reimbursement efficiency.

Requirements

High school diploma or equivalent; Associate’s degree or higher in healthcare administration or related field preferred.
Minimum of 2 years experience in medical billing, coding, or reimbursement processing within the healthcare industry.
Strong understanding of insurance claim processes, medical terminology, and healthcare reimbursement systems.
Proficiency with electronic health record (EHR) systems and billing software.
Excellent communication and organizational skills with attention to detail.
Strong analytical skills daily to review claims and identify discrepancies that could delay payment.
Effective communication skills are essential for interacting with insurance representatives, patients, and internal teams to resolve issues and clarify coverage.
Attention to detail ensures accuracy in claim submission and documentation, reducing the risk of denials.
Familiarity with billing software and EHR systems enables efficient processing and tracking of claims.
Staying current with healthcare regulations and payer policies allows the specialist to adapt processes and maintain compliance, ultimately supporting the organization's financial stability.

Nice To Haves

Experience working with multiple insurance payers including Medicare, Medicaid, and private insurers.
Familiarity with healthcare compliance regulations such as HIPAA and the Affordable Care Act.
Advanced proficiency in data analysis and reporting tools.
Demonstrated ability to manage complex claim appeals and denials effectively.

Responsibilities

Prepare and submit insurance claims accurately and in a timely manner to ensure prompt reimbursement.
Review and analyze Explanation of Benefits (EOBs) and remittance advices to identify and resolve payment discrepancies or denials.
Communicate with insurance companies, patients, and internal teams to clarify coverage details and resolve outstanding reimbursement issues.
Maintain detailed records of claims, payments, denials, and appeals to support audit readiness and reporting requirements.
Stay informed about changes in insurance policies, billing regulations, and reimbursement guidelines to ensure compliance and optimize revenue.