Medical Reimbursement Specialist

CHARTER OAK HEALTH CENTER INC; Hartford (CT); On-site; USD 30,000 - 39,000; Full time

Job summary

Charter Oak Health Center in Hartford, CT is seeking a Medical Reimbursement Specialist to manage and resolve outstanding insurance and patient accounts, ensuring timely and accurate reimbursement. You will work with ECW outsourcing, coding and front-end staff, payers to reduce AR days and improve cash flow.

Requires 2–4 years experience in healthcare billing; associate or higher degree a plus. This role emphasizes attention to payer guidelines and accurate data entry, using Excel for audits and

Qualifications

• Minimum 2–4 years of experience in healthcare accounts receivable, medical billing, and reimbursement.
• Experience with FQHC, hospital, or physician practice billing is a plus.
• Knowledge of CPT, ICD-10, and HCPCS coding principles.

Responsibilities

• Follow up on unpaid claims with payers promptly.
• Investigate and resolve claim denials and underpayments.
• Review EOBs and ERAs for accuracy.
• Submit corrected claims and appeals with documentation.
• Identify root causes of denials and share trends with leadership.
• Ensure compliance with payer guidelines and deadlines.
• Collaborate with front-end and coding teams to fix eligibility or coding issues.

Skills

Denial management

Medical billing

EHR systems

Accounts receivable

Analytical skills

Education

High school diploma or equivalent

Associate or bachelor’s degree in healthcare administration

Tools

eClinicalWorks

Job description

Job Details

Job Location: Hartford, CT 06106

Salary Range: $22.00 - $28.00

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

QualificationsProfessional 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