Reimbursement Specialist

• 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

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