Reimbursement Specialist

About this role

About the role: The Reimbursement Specialist is responsible for managing the full reimbursement lifecycle, including claim preparation, submission, and account follow-up to ensure accurate and timely reimbursement. This role serves as the primary owner of assigned accounts receivable activities, and collaborates with internal teams to resolve billing issues, reduce outstanding balances, and maximize revenue collection.

Responsibilities: Review claims and billing documentation for accuracy and completeness prior to submission to ensure compliance with payer requirements and reimbursement guidelines Submit claims through TrueSight, payer portals, and invoicing processes for insurance, reseller, alternate funding, and other non-traditional reimbursement channels Monitor submitted claims and invoices to ensure timely processing, payment, and resolution of outstanding balances Perform timely follow-up with insurance companies, patients, caregivers, resellers, and other external partners to resolve payment issues and facilitate reimbursement Review, identify, and correct claim rejections, billing errors, and submission issues to support timely resubmission and payment Investigate claim denials, underpayments, and outstanding balances to determine root causes and implement appropriate resolution strategies Submit appeals and supporting documentation for denied or underpaid claims to maximize reimbursement Manage patient financial responsibilities, including establishing payment plans, sending payment links, and coordinating payment resolution prior to shipment and case completion Monitor and manage assigned Accounts Receivable to reduce aging balances and support departmental collection goals Maintain accurate and timely documentation of all billing, collection, and account activity within applicable systems Collaborate with internal teams to identify trends, resolve reimbursement barriers, and improve billing and collection processes Maintain compliance with payer requirements, reimbursement regulations, and company policies Maintain confidentiality and adhere to HIPAA standards when handling Protected Health Information (PHI) Maintain current knowledge of payer requirements, billing processes, reimbursement guidelines, and industry regulations May be required to perform other duties as assigned Minimum Qualifications: High School Diploma or equivalent 1–3 years of experience in medical reimbursement, DME, medical billing, or healthcare revenue cycle management 1-3 years of experience using medical billing or claims management software, such as TrueSight 1-3 years of experience using payer and/or clearinghouse portals, such as MyCGS or Inovalon Strong attention to detail, organization, problem-solving, and follow-up skills Strong written and verbal communication skills Ability to effectively manage multiple and shifting priorities in a fast-paced environment Ability and willingness to travel within the U.S.