The Insurance Reimbursement Specialist is responsible for the collection, follow-up, and appeals of insurance claims. Essential to this position is the ability to manage all insurance follow-up for maximum insurance reimbursement. To include outbound and inbound insurance carrier calls, reprocessing claims, drafting appeals, working denials, and resolving unpaid claims.
Qualifications- High school diploma or GED required.
- Minimum of three years of experience in medical insurance follow-up, collections, denial management, and reimbursement.
- Knowledge of both in-network and out-of-network facility and professional claims.
- Experience working with commercial insurance carriers, including UHC, Cigna, Aetna, BCBS, Marketplace plans, workers’ compensation, and third-party liability claims, is preferred.
- Strong knowledge of claim status follow-up, denial resolution, corrected claims, reconsiderations, and appeals.
- Ability to read, analyze, and interpret EOBs, ERAs, payer correspondence, denial codes, and reimbursement information.
- Proven experience preparing and submitting appeals in a high-volume claims environment.
- Experience working in a production-based environment and consistently meeting productivity, accuracy, and quality expectations.
- Strong verbal and written communication skills.
- Ability to clearly communicate claim issues, reimbursement discrepancies, and appeal requests to insurance representatives.
- Excellent analytical, problem-solving, research, and negotiation skills.
- Ability to prioritize assignments, manage multiple deadlines, and work independently with minimal supervision.
- Positive attitude and demonstrated ability to collaborate effectively with team members and leadership.
- Knowledge of EPOWERDOC and Centricity is preferred.
- Proficiency with Microsoft Windows, Excel, Word, payer portals, and other medical billing applications.
- Ability and willingness to learn new software, payer systems, and reimbursement processes.
- Typing speed of 45–60 words per minute preferred.
JOB RESPONSIBILITIES/DUTIES
• Work assigned claims accurately, efficiently, and within established departmental and corporate timeframes.
• Understand and stay informed of changes to procedures, billing guidelines, and laws for specific insurance carriers or payers.
• Research claim status, payment discrepancies, denials, coding or billing issues, authorization concerns, eligibility problems, and payer-specific requirements.
• Actively follow up and collect on all claims, including resolution of any billing errors following established procedures.
• Follow all departmental policies, standard operating procedures, compliance requirements, and leadership directives.
• Protect patient information and comply with HIPAA and all organizational confidentiality requirements.
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction, and attendance.
• Perform other duties as assigned by department manager.
WORKING CONDITIONS
• Frequent speaking, listening, using a headset, use of hands/fingers across keyboard or mouse, handling other objects, and long periods working at a computer.
• Service center with moderate noise level due to representatives talking, computers, printers, and floor activity.
• While performing duties of this job, the employee is frequently required to stand, walk, and sit.
• Must submit to random drug screenings.
Full-Time Benefit Perks:
- Health benefits start on the first of the month after hire
- Medical, dental, and vision plans with sliding-scale premiums
- 100% coverage for preventive health services
- HSA and FSA options available
- Company-paid life insurance and long-term disability
- 401(k) with contributions starting after 30 days
- 100% match on the first 4%,
- Full vesting after 3 years
- Access to exclusive employee discounts on travel, fitness, shopping, and more
- Paid Time Off
- Paid Holiday
Join us and make a significant impact on our company’s success in reaching our target audience and driving business growth.
Skills Required
- High school diploma or GED
- Minimum three years of experience in medical insurance follow-up, collections, denial management, and reimbursement
- Knowledge of in-network and out-of-network facility and professional claims
- Experience with commercial insurance carriers, workers' compensation, and third-party liability claims
- Knowledge of claim status follow-up, denial resolution, corrected claims, reconsiderations, and appeals
- Ability to read and interpret EOBs, ERAs, payer correspondence, denial codes, and reimbursement information
- Experience preparing and submitting appeals in a high-volume claims environment
- Experience working in a production-based environment while meeting productivity, accuracy, and quality expectations
- Strong verbal and written communication skills
- Analytical, problem-solving, research, and negotiation skills
- Ability to prioritize assignments, manage deadlines, and work independently
- Ability to collaborate effectively with team members and leadership
- Knowledge of EPOWERDOC and Centricity
- Proficiency with Microsoft Windows, Excel, Word, payer portals, and medical billing applications
- Ability and willingness to learn new software, payer systems, and reimbursement processes
- Typing speed of 45-60 words per minute
- Compliance with HIPAA and organizational confidentiality requirements
- Ability to submit to random drug screenings
What We Do
RoundTable Medical Consultants is a professional services firm based in Houston, Texas, specializing in medical billing, coding, and revenue cycle management. They provide comprehensive administrative support for healthcare providers, including medical verification, credentialing, MVA, and full HIPAA compliance services. Their mission is to optimize financial outcomes and ensure regulatory adherence for medical practices through expert billing and coding consultancy.
