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Lead Reimbursement Specialist

Sarasota, FL 34236-4042

Posted: 09/12/2023 Job Type: Permanent/Direct Hire Industry: Other (HR, Admin, Mkt, Sales) Job Number: 24209 Pay Rate: $ 22.00 - $ 25.00

Job Description

The Lead Reimbursement Specialist is responsible for promoting department efficiency, process improvement implementation for billing specialists, training billing specialists on new processes and tracking/resolving reimbursement and posting errors. This role performs payment posting, claims corrections, and insurance accounts receivable follow up. The Specialist is responsible for communicating with staff, payers and patients, answering inquiries on a timely basis according to written procedures, and for appropriate follow-up on assigned accounts until adjudicated. 


The Lead Reimbursement Specialist handles billing calls and other forms of communication (payer/patient portals, e-mails, faxes, etc.) from payer's and patients while maintaining confidentiality and adhering to HIPAA guidelines/regulations. The Lead Reimbursement Specialist must have an in-depth understanding of healthcare billing and coding processes as well as be able to understand and navigate complicated insurance policies and regulations. 




  • Create, implement and train on improved processes to increase reimbursement of services
  • Obtain missing or incorrect data to process a complete and correct bill on a timely basis in order to assure expedited payment
  • Collect and report missing/incorrect data to supervisor as directed
  • Document all required billing activities in the practice management/electronic health records system as directed
  • Track billing errors on a daily basis to assure quality claims submission
  • Post insurance payments and patient payments 
  • Correct payment and adjustment posting error's
  • Work insurance credit balances and process insurance refunds by first requesting the payer to process a takeback of payment
  • Work with other billing specialists on claims projects for payers
  • Serve as a role model for consistent demonstration of customer service standards
  • Adhere to all departmental policies and procedures, including established HIPAA privacy and security procedures
  • Through these activities demonstrate an understanding of and commitment to core values of respect, knowledge, responsibility, health, compassion and access; practice these values in relations with internal and external clienteles 
  • Participate and assist with quality management reporting and projects
  • Attend training sessions as specified by department leadership
  • Clerical duties, including, but not limited to filing, typing, forms rotations, copying, answering calls and voicemail and other duties as assigned

Job Requirements

  • High School diploma or equivalent required. Completion of Medical Insurance Billing and Coding course preferred. 
  • 5 + years revenue cycle billing experience 
  • Minimum 2 years Resolute Professional billing EPIC experience
  • 3-5 years creating, implementing and training on billing processes
  • 5 + years' experience working with private/commercial/marketplace/Medicaid/Medicare insurance payers and different plans
  • Working knowledge of CPT and ICD-10 billing codes
  • Working knowledge of spreadsheets and word processing 
  • Strong organizational and analytical skills
  • Accurate and detail-oriented
  • Good written and oral communication skills and an ability to adhere to strict deadlines
  • Ability to work well both with others and independently and to respond sensitively to patients, clients, staff, and volunteers
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