Reimbursement Specialist

• Track, report, and resolve complex outstanding claims
• Troubleshoot Explanation of Benefits (EOBs) and identify reasons for claim denials or low payments
• Appeal non-covered or underpaid claims through external review channels
• Follow up on unpaid claims to ensure timely resolution
• Drive positive coverage determinations through external appeals
• Maintain accurate documentation of payer communications, correspondence, and insurance research
• Collaborate with the billing tool provider, finance, and client services teams to streamline billing operations and optimize reimbursement processes

Reimbursement Specialist supporting claims appeals for Guardant Health’s precision oncology testing business

Reimbursement Specialist II

Reimbursement Specialist managing claims follow-up and external appeals for Guardant Health’s precision oncology testing business. Resolving denials, underpayments, and coverage issues to improve reimbursement outcomes.

• Serve as a subject-matter expert on reimbursement, access, and coverage issues
• Educate healthcare providers, office staff, and practice managers on insurance, reimbursement, coding, billing, formulary, prior authorization, and appeals processes
• Support patient access to client products by resolving reimbursement and coverage challenges
• Act as a liaison between providers, manufacturers, pharmacies, and payers
• Collaborate with patient assistance and reimbursement support services
• Inform office staff about coverage and payer policy changes within assigned territories
• Probe office processes and identify root causes of access or reimbursement issues
• Deliver interactive educational presentations at provider sites of service
• Provide client-approved reimbursement information regarding client products
• Travel weekly to healthcare offices, including potential overnight stays
• Perform other related duties as assigned

Field Reimbursement Specialist helping Cencora patients access specialty medications

Field Reimbursement Specialist

Field Reimbursement Specialist helping Cencora patients access specialty medications. Educating healthcare offices and resolving pharmacy benefit, coverage, and reimbursement barriers across a multistate territory.

• Responsibilities include patient account follow up on all types of hospital claims.
• This includes following accounts through secondary and subsequent payers.
• Must have thorough knowledge of hospital managed care contracts, standard collection processes and state and federal regulations.
• An understanding of medical terminology and diagnosis and procedure coding is needed.
• Review all accounts with payments previous day.
• Review and resolve reminder queue daily.
• File secondary, tertiary, etc. paper claims as needed.
• Maintains established policies and procedures, objectives, quality assurance programs and safety standards.
• Participates in educational programs and in-services.
• Provide customer service for patients, internal customers and insurance companies as needed.
• Performs other duties as assigned.

Reimbursement Specialist managing hospital claims in DFW area

Reimbursement Specialist managing patient account follow up on hospital claims. Requires understanding of hospital contracts and payer rules in DFW area with remote work option.

• Support post-submission reimbursement activities
• Focus on denials management and appeals
• Investigate denials, prepare and submit appeals
• Follow up with payers to ensure timely and accurate reimbursement
• Manage various denial types and prepare higher-level appeals
• Review and interpret Explanation of Benefits (EOBs)
• Contact insurance companies and utilize payer portals
• Submit corrected claims and appeals in accordance with payer guidelines
• Maintain accurate documentation of denials and appeals actions
• Assist in developing payer-specific appeals workflows
• Communicate with patients and providers regarding appeals related questions
• Critically assess challenging situations and escalate when appropriate
• Ensure compliance with billing regulations and company policies

Reimbursement Specialist handling post-submission activities for Naveris molecular diagnostics

Reimbursement Specialist – Appeals

Reimbursement Specialist managing denials and appeals in the reimbursement department of Naveris. Focus on claims management in the context of molecular diagnostics for viral-associated cancers.

• Supports execution of reimbursement strategies aligned with business priorities and product lifecycle needs
• Provides reimbursement and health policy guidance to clinical, regulatory, marketing, and sales partners
• Contributes to evidence planning by partnering with HEOR to identify payer‑relevant data needs
• Analyzes reimbursement landscapes and supports development of coding, coverage, and payment pathways and internal and external communication tools
• Educates internal teams on reimbursement requirements, payer trends, and implications for product adoption
• Identifies reimbursement barriers and supports implementation of solutions to improve patient access
• Develops and delivers reimbursement education for internal teams and external stakeholders
• Performs other duties, as required

Senior Reimbursement Specialist managing medical device reimbursement strategies

Senior Reimbursement Specialist

Senior Reimbursement Specialist managing reimbursement strategies and providing health policy guidance in medical devices. Collaborating with various teams to enhance patient access and coding solutions.

• Executes and optimizes US reimbursement strategies that support business objectives across prioritized product and therapy areas.
• Provides reimbursement and health policy guidance to product development, working in close partnership with clinical, regulatory, marketing, and sales teams.
• Partners with HEOR to assess global evidence needs and support development of payer‑relevant data.
• Analyzes reimbursement landscapes and contributes to coding, coverage, and payment pathway development including evaluation of relevant data analytics pertaining to health policy initiatives.
• Educates internal leaders and field teams on reimbursement requirements and business impact.
• Builds and maintains relationships with payers, government agencies, professional societies, and advocacy groups.
• Identifies reimbursement barriers, develops initiatives, and supports implementation of programs that improve market access.
• Designs and delivers reimbursement education for internal and external stakeholders.
• Represents, as a leader, the expertise and perspective of the Reimbursement/Market Access function to the business divisions it supports.
• Performs other duties, as required.

Senior Reimbursement Specialist optimizing US reimbursement strategies at Merit Medical

Senior Reimbursement Specialist optimizing US reimbursement strategies to support business objectives for Merit Medical. Collaborating with multiple teams and building relationships with payers and agencies.

• Provide high quality customer service
• Effectively interface with patients, patient’s families, national payers, home cares and medical doctor’s offices
• Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices
• Submit and obtain prior authorizations as required by payer
• Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval
• Accurately enter and maintain data as required in client database and patient files
• Utilize the client database to monitor outstanding items on each client case file
• Ensure files are complete so team can determine the current status
• Participate in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases
• Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient
• Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies
• Educate patients, prescribers, and others regarding program requirements, and facilitate referrals
• Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures

Provide high quality reimbursement support in the pharmaceutical industry

Provide high quality customer service as a Sr. Reimbursement Specialist. Interface with patients and facilitate the reimbursement process for a pharmaceutical support leader.

• Assure all insurance claims are processed timely, accurately, and efficiently
• Secure payments from both contracted and non-contracted insurance entities as well as customers
• Work closely with Customer Sales Support to assure data accuracy and communication of requirements from health insurance plans
• Review medical criteria to assure patient documentation meets standards
• Carefully review all patient related data and documentation for accuracy prior to claim submission
• Create and submit healthcare claims to insurance companies
• Communicate with patients to advise on status of insurance claims, as necessary
• Contact patients regarding collection of outstanding invoices
• Field inbound calls from patients regarding inquiries related to insurance claims
• Make outbound investigational calls to insurance providers to determine status of outstanding claims
• Negotiate structured payment plans
• Access CRM to receive and provide up to date patient claim information
• Keep up to date with specifications on all of Tandem products and services
• Confirm completion of required training plan before assuming job responsibilities
• Ensure work is performed in compliance with company policies including Privacy/HIPAA and other regulatory, legal, and safety requirements

Reimbursement Specialist processing insurance claims for Tandem Diabetes Care

Reimbursement Specialist for Tandem Diabetes Care, processing insurance claims and coordinating with patients and insurance providers. Ensuring compliance and accuracy in billing processes.

Reimbursement Specialist jobs in United States

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Reimbursement Specialist II

Field Reimbursement Specialist

Reimbursement Specialist

Reimbursement Specialist – Appeals

Senior Reimbursement Specialist

Senior Reimbursement Specialist

Senior Reimbursement Specialist

Reimbursement Specialist