Medical Reimbursement Specialist

Job Summary:

Charter Oak Health Center is seeking an Medical  Reimbursement Specialist to join our team. In this role, you will be responsible

for managing and resolving outstanding insurance and patient accounts to ensure timely and accurate reimbursement. This role focuses on claim follow-up, denial resolution, payment posting review, and the identification of trends impacting revenue. The specialist works collaboratively with the ECW outsourcing company, coding and front-end staff, and payers to reduce accounts receivable days and improve cash flow.
Essential Position Duties
•    Perform timely follow-up on unpaid claims with insurance companies, including commercial, Managed Medicare, Medicare, and Medicaid payers 

•    Investigate and resolve claim denials, underpayments, and rejections 

•    Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) for accuracy 

•    Submit corrected claims, appeals, and supporting documentation as needed 

•    Identify root causes of denials and communicate trends to leadership and relevant departments 

•    Ensure compliance with payer guidelines, contractual agreements, and regulatory requirements 

•    Work assigned work queues (WQs) and prioritize accounts based on aging and dollar value 

•    Collaborate with front-end and coding teams to correct eligibility, authorization, or coding issues 

•    Monitor timely filing limits and ensure claims are processed within required deadlines 

•    Document all account activity clearly and accurately in the practice management system (e.g., eClinicalWorks) 

•    Assist with reconciliation of payments and resolution of credit balances when applicable 

•    Participate in audits, process improvement initiatives, and team meetings

•    Works with team members on special projects using Excel and communicates results effectively, while also completing other assigned tasks.

•    Performs other job-related or miscellaneous duties as assigned by management.

•    Comply with the agency’s Mission.

•    Must maintain appropriate professionalism and attendance
 

Qualifications

Professional Experience/Educational Requirements

Education

•    High school diploma or equivalent required 
•    Associate or bachelor’s degree in healthcare administration, Revenue Cycle, or related a plus.

Experience

•    Minimum of 2–4 years of experience in healthcare accounts receivable, medical billing, and reimbursement
•    Experience with FQHC (a plus), hospital, or physician practice billing
•    Experience with denial follow-up
•    Knowledge of basic medical coding and third-party operating procedures and practices
•    Knowledge of ERA’s/RA’s and EOBs.

Knowledge, Skills, and Abilities

•    Strong understanding of payer guidelines, including Medicare, Medicaid, and commercial insurance
•    Knowledge of CPT, ICD-10, and HCPCS coding principles 
•    Familiarity with denial management and appeals processes 
•    Experience with electronic health records (EHR) and billing systems (e.g., eClinicalWorks) 
•    Strong analytical and problem-solving skills 
•    Ability to manage high-volume workloads and meet productivity standards 
•    Excellent communication and organizational skills 
•    Detail-oriented with a focus on accuracy and compliance