Reimbursement Specialist

Advanced Rx Management; Florida; Remote; USD 52,000 - 76,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Flexible spending account

Health insurance

Life insurance

Paid time off

Referral program

Vision insurance

Job summary

Advanced Rx Management, a Sunrise, Florida-based pharmaceutical services company, seeks a Reimbursement Specialist to own the full revenue cycle for Workers' Compensation and Personal Injury prescription claims. You will drive timely reimbursement, reduce AR aging, and ensure accurate billing across a national client base.

The ideal candidate is analytical, detail-oriented, and proactive, with experience in appeals, denials management, and payer communications.

Qualifications

• Minimum 2 years of medical billing and collections experience.
• Workers' Compensation billing experience preferred.
• Strong knowledge of EOB interpretation and ICD-10 coding.
• Experience with appeals and insurance carrier follow-up.
• Ability to analyze denials and trends.

Responsibilities

• Manage full billing and collections for a defined book of Workers' Compensation and Personal Injury prescription claims.
• Maintain and thoroughly work a minimum of 40+ patient accounts, ensuring progress toward resolution.
• Review aging reports daily to reduce 60/90/120+ day AR and accelerate reimbursement.
• Analyze EOBs and denials to identify root causes and execute resolution strategies.
• Prepare and submit timely appeals with complete documentation.
• Communicate professionally with carriers, adjusters, attorneys, and internal teams to drive resolution.

Skills

Analytical thinking

Problem solving

Attention to detail

Communication skills

Independent worker

Multitasking

Tools

Microsoft Excel

Job description

Company: Advanced Rx

Location: U.S.-based Remote

Industry: Pharmaceutical Services / Physician Dispensing

Position Summary

Advanced Rx Management, a rapidly growing pharmaceutical services company headquartered in Sunrise, Florida, is seeking a results-drivenReimbursement Specialistto support our expanding national client base.

This role is responsible for managing the full revenue cycle for Workers' Compensation and Personal Injury prescription claims, with direct accountability for reducing Accounts Receivable and driving timely, accurate reimbursement. This is not a task-based billing position - the selected candidate will own a defined book of business and be responsible for resolving claims efficiently, minimizing AR aging, identifying denial trends, and improving overall cash flow performance.

The ideal candidate is analytical, detail-oriented, and proactive, with the ability to think critically through complex billing issues, identify root causes of denials or underpayments, and strategically move accounts toward resolution. We are seeking a team-oriented professional who values accuracy, accountability, and excellence in execution, and who contributes meaningfully to improved reimbursement outcomes in a fast-paced, growth-focused environment.

Key Responsibilities

• Manage the full billing and collections lifecycle for a defined book of Workers' Compensation and Personal Injury prescription claims, with direct accountability for AR performance and aging metrics
• Maintain and thoroughly work a minimum of 40+ patient accounts, ensuring consistent progress toward resolution
• Review and prioritize aging reports daily to proactively reduce 60/90/120+ day AR and accelerate reimbursement
• Analyze EOBs, notices of disallowance, state fee schedule variances, and payment discrepancies to identify root causes and independently execute the appropriate resolution strategy (corrected claim submission, appeal, adjuster outreach, escalation, or legal follow-up)
• Track and resolve unpaid and underpaid claims to ensure accurate reimbursement in accordance with contractual terms and state fee schedules
• Prepare and submit timely, comprehensive appeals with complete medical and billing documentation to support dispute resolution
• Ensure claim accuracy through detailed review and correction of demographic information, insurance data, ICD-10 diagnoses, CPT coding, and billing modifiers as needed
• Identify denial patterns and recurring payer issues; recommend and support process improvements to reduce repeat denials and strengthen revenue cycle performance
• Maintain detailed, accurate account documentation to support compliance, reporting, and effective follow-up
• Communicate professionally and persistently with insurance carriers, adjusters, attorneys, and internal clinical teams to drive timely account resolution
• Meet or exceed defined KPIs related to:
• AR reduction targets
• Collection rate improvement
• Appeal success rates
• Productivity standards (accounts worked daily)
• Quality and accuracy benchmarks
• Support special projects and revenue cycle improvement initiatives aligned with company growth objectives

Qualifications

• Minimum 2 years of medical billing and collections experience (preferred)
• Workers' Compensation billing experience strongly preferred
• Strong knowledge of EOB interpretation, understand ICD-10 coding, and denial management
• Proven experience with appeals and insurance carrier follow-up
• Strong analytical and problem-solving skills
• High attention to detail and ability to manage multiple accounts simultaneously
• Excellent written and verbal communication skills
• Proficient in Microsoft Excel
• Ability to work independently in a fast-paced, growth-oriented environment

Ideal Candidate Profile

The successful candidate will demonstrate:

• Critical thinking beyond task execution
• Ownership of account resolution
• Persistence in follow-up and escalation
• Ability to identify patterns and recommend process improvements
• Professionalism in communication with payers and legal entities

Schedule:

Mon-Fri 8:00am to 5:00pm

Remote

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Experience:

• billing medications/pharmacy-related services: 1 year (Preferred)
• Workers' compensation billing and claims: 1 year (Preferred)