Reimbursement Specialist

Paycom - ATS; Jacksonville (NC); On-site; USD 60,000 - 76,000; Full time

Job summary

Paycom - ATS is seeking a Reimbursement Specialist to support revenue cycle leadership with reimbursement program development. You will analyze financial data, model reimbursement scenarios, and prepare reports for contract negotiations and payment validation in a healthcare setting.

The role requires billing and coding experience, strong analytical skills, and effective communication with leadership. Collaboration across departments is essential to identify revenue opportunities.

Qualifications

• Bachelor’s degree preferred; associates accepted with 3 years billing or coding experience.
• If only a high school diploma, at least 6 years billing or coding experience required.
• Two years of analysis in financial, reimbursement modeling or healthcare data preferred.

Responsibilities

• Oversee data gathering, financial modeling and ad hoc reports for contract negotiations.
• Validate claim payments and support senior leadership decisions.
• Maintain and audit financial models in the contract management system.
• Investigate over/underpayments and participate in special projects.

Skills

Data analysis

Billing

Coding

Communication

Education

Bachelor’s degree

Associate degree in business or healthcare

Tools

Microsoft Office

Job description

The Reimbursement Specialist requires a candidate with an intimate understanding of the coding and reimbursement landscape, as well as a commitment to delivering exceptional customer service. This position is responsible for communicating best practices and trends in reimbursement models and other related regulatory matters and will routinely interact with leadership to field questions/concerns. The Reimbursement Specialist will support Revenue Cycle Leadership in the delivery of the organizations evolving reimbursement program. This position will have experience in coding and billing processes within a healthcare setting. This position will oversee the data gathering, financial modeling, and creation of ad hoc financial reports relating to managed care contracting to be used for contract negotiations and validating claim payments to help assist senior level leadership in decision making processes and identification of revenue enhancing opportunities. The Reimbursement Specialist is also responsible for maintaining and auditing the current financial models in the current database system used for contract management, for accurate reporting and investigating over and under payments for claims variances and participating in various department related special projects.Education/Certification:Bachelor’s degree in an appropriate discipline preferred. Associates degree in business or healthcare field and three (3) years billing, and/or coding experience required. If high school diploma, then at least six (6) years billing, and/or coding experience required.Qualifications:Two (2) years of analysis in financial, reimbursement modeling or healthcare data or managed care negotiations with a healthcare organization, provider group, or health plan/payer preferred. Experience in billing or coding in a healthcare organization required. Data analysis and reporting Billing/Collections, Insurance Claims, Microsoft Office, good communication skills are essential.