Senior Reimbursement Specialist - Complex Claims & Denials

Tryon Med; Charlotte (NC); Presencial; USD 55.000 - 85.000; Jornada completa

Descripción de la vacante

Tryon Med is seeking an experienced Account Reimbursement Specialist III to lead complex insurance reimbursement efforts in a physician practice setting. You will resolve high-dollar, aged accounts with sophisticated payer requirements and provide guidance to other RCM team members.

You will research payer policies, prepare appeals, analyze denials, and collaborate with leadership to implement improvements in reimbursement practices and revenue cycle performance.

Formación

• Minimum five years in healthcare revenue cycle or medical billing
• Knowledge of payer policies and denial resolution strategies
• Experience with insurance accounts, EOBs, remittance advice, and adjustments
• Strong analytical and research skills with payer policy application
• Excellent verbal and written communication; ability to mentor others

Responsabilidades

• Perform all responsibilities of Reimbursement Specialists I and II
• Serve as SME for complex reimbursement and denial issues
• Manage complex, high-dollar, aged accounts with payer intervention
• Conduct advanced payer policy research and appeals when needed
• Analyze EOBs, remittance advice, and billing discrepancies for resolution
• Develop and submit complex reconsiderations and appeals
• Research claims using payer portals and supporting documentation
• Escalate difficult denials and coordinate with leadership
• Coach peers and share knowledge on trends and best practices
• Identify recovery opportunities for previously denied or underpaid claims
• Maintain payer workflows and reference materials
• Support onboarding and training of RCM staff
• Ensure accurate account documentation and adherence to standards
• Maintain knowledge of payer policies and regulatory changes

Conocimientos

Revenue cycle

Denial resolution

Payer research

Analytical thinking

Communication

Mentorship

Regulatory knowledge

Educación

High school diploma

Associate degree in Business/Healthcare Administration

Herramientas

Athenahealth/AthenaOne

Descripción del empleo

Tryon Med is seeking an experienced Account Reimbursement Specialist III to lead complex insurance reimbursement efforts in a physician practice setting. You will resolve high-dollar, aged accounts with sophisticated payer requirements and provide guidance to other RCM team members.

You will research payer policies, prepare appeals, analyze denials, and collaborate with leadership to implement improvements in reimbursement practices and revenue cycle performance.