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Reimbursement Specialist
Advanced Rx. Manage the full billing and collections lifecycle for a defined book of Workers’ Compensation and Personal Injury prescription claims .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing the billing and collections lifecycle for Workers’ Compensation and Personal Injury claims, with strong analytical skills for EOB interpretation and denial management. Proficient in ICD-10 coding and appeals processes, ensuring compliance and accuracy in all billing activities.
Highest-signal resume keywords
Medical Billing And Collections ExperienceWorkers’ Compensation Billing ExperienceEOB InterpretationICD-10 CodingDenial Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Billing ModifiersCPT CodingClaims SubmissionAppeals ProcessAccount DocumentationAging Reports AnalysisReimbursement AccelerationPayment Discrepancy ResolutionRevenue Cycle ImprovementKPI Achievement
Soft Skills
Analytical SkillsProblem-Solving SkillsAttention To DetailWritten CommunicationVerbal Communication
Tools & Technologies
Microsoft Excel
Industry Keywords
Workers’ CompensationPersonal InjuryInsurance Carrier CommunicationPatient Accounts ManagementCompliance
About the role
Key responsibilities & impact- Manage the full billing and collections lifecycle for a defined book of Workers’ Compensation and Personal Injury prescription claims
- Maintain and thoroughly work a minimum of 40+ patient accounts
- Review and prioritize aging reports daily to reduce 60/90/120+ day accounts receivable and accelerate reimbursement
- Analyze EOBs, notices of disallowance, state fee schedule variances, and payment discrepancies
- Execute resolution strategies including corrected claim submission, appeals, adjuster outreach, escalation, and legal follow-up
- Track and resolve unpaid and underpaid claims in accordance with contractual terms and state fee schedules
- Prepare and submit timely appeals with complete medical and billing documentation
- Review and correct demographic information, insurance data, ICD-10 diagnoses, CPT coding, and billing modifiers
- Identify denial patterns and recurring payer issues and support process improvements
- Maintain detailed account documentation for compliance, reporting, and follow-up
- Communicate with insurance carriers, adjusters, attorneys, and internal clinical teams
- Meet or exceed KPIs for AR reduction, collection rate improvement, appeal success, productivity, quality, and accuracy
- Support special projects and revenue cycle improvement initiatives
Requirements
What you’ll need- Minimum 2 years of medical billing and collections experience (preferred)
- Workers’ Compensation billing experience strongly preferred
- Strong knowledge of EOB interpretation
- Understanding of ICD-10 coding
- Denial management experience
- Proven experience with appeals and insurance carrier follow-up
- Strong analytical and problem-solving skills
- High attention to detail and ability to manage multiple accounts simultaneously
- Excellent written and verbal communication skills
- Proficient in Microsoft Excel
- Ability to work independently in a fast-paced, growth-oriented environment
- Experience billing medications/pharmacy-related services: 1 year (Preferred)
- Workers’ compensation billing and claims: 1 year (Preferred)
Benefits
Comp & perks- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Vision insurance
- Remote work arrangement
- Monday-Friday schedule, 8:00am to 5:00pm