Reimbursement Specialist III

POSITION
Reimbursement Specialist llI
(Home Infusion/Specialty Pharmacy Claims)

Schedule Details 
Location: Laguna Hills, CA (This is an on-site opportunity).
Schedule: Monday to Friday, 8:00AM to 4:30PM PST
Compensation:$33 to $36 Hourly, DOE.
Offer will be based on experience, skills, and qualifications.

Job Summary
We are seeking a highly skilled Reimbursement Specialist to join our dynamic team. The ideal candidate will be responsible for ensuring accurate and timely collections to maximize reimbursement experience. This role is essential in ensuring accurate and timely collections and maximizing reimbursement through effective interactions with third-party payers, insurance plans, and patients. The candidate will possess strong analytical skills, be detail-oriented, and excel in submitting claims, appeals, and resolving discrepancies with minimal supervision.

DUTIES & 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.

REQUIRED QUALIFICATIONS

• Minimum of 3 years of hands-on experience in medical collections and reimbursement experience.
• In depth Knowledge of managed care, commercial insurance, ICD-10, CPT, HCPC codes, J billing codes, and medical terminology, along with CMS HCFA 1500 forms & Electronic Billing.
• Experience with Benefit Investigation and Patient Responsibility Agreements.
• Experience with automated billing systems, CPR+ is preferred.
• Advanced proficiency in Microsoft Word, Excel, and Outlook.

Preferred Qualifications 

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

ADDITIONAL INFORMATION

• Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
• Great pay and general compensation structures
• Employee assistance program to assist with mental health, legal questions, financial counseling, etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company-sponsored outings and team-building events
• Casual Fridays

CORE VALUES 
We believe our culture is defined by how we work together and serve our community.

• Integrity: Upholding the highest ethical standards, transparency, and honesty in every claim, transaction, and interaction.
• Teamwork: Collaborating seamlessly across departments to achieve shared goals and overcome complex financial challenges.
• Service: Committing to exceptional care, clarity, and support for our patients, partners, and colleagues.
• Passion: Bringing energy, enthusiasm, and a strong drive for excellence to the healthcare revenue space.
• Humility: Remaining open to continuous learning, valuing diverse perspectives, and putting the team's success first.