Senior Reimbursement Specialist: Complex Payer Claims

Tryon Medical Partners; Charlotte (NC); On-site; USD 65,000 - 90,000; Full time

Job summary

Tryon Medical Partners is seeking an Account Reimbursement Specialist III to serve as a subject matter expert in complex insurance reimbursement, denial resolution, and payer adherence. The role handles high-dollar, aged accounts and advanced research to determine optimal resolution strategies.

You will identify systemic denial trends, perform root-cause analysis, and collaborate with RCM leadership to improve reimbursement, reduce denials, and maximize net collections.

Qualifications

• Minimum five (5) years in healthcare revenue cycle or medical billing in a physician office or ambulatory setting.
• Strong knowledge of physician billing, claim submission, payer rules, and AR follow-up.
• Solid understanding of ICD-10, CPT, HCPCS, modifiers, and coding-related issues.
• Analytical problem-solving with ability to research payer policies and apply guidelines.
• Ability to mentor peers and work independently with complex accounts.

Responsibilities

• Performs all responsibilities of Account Reimbursement Specialist I and II.
• Serve as SME for complex reimbursement, denial resolution, and payer requirements.
• Manage complex, high-dollar, aged, and escalated insurance accounts requiring advanced investigation.
• Research payer policies, contracts, and medical necessity to determine resolution strategy.
• Analyze EOBs, remittance advice, and coding issues to resolve accounts.
• Develops and submits complex appeals and corrected claims to maximize reimbursement.
• Provide guidance to junior staff and share best practices on denial management.

Skills

Analytical thinking

Problem solving

Communication skills

Customer service

Independent work

MS Excel

Education

High school diploma or equivalent

Associate degree in Business, Healthcare Administration, Medical Billing, Revenue Cycle Management, or related field

Tools

Athenahealth/AthenaOne

Job description

Tryon Medical Partners is seeking an Account Reimbursement Specialist III to serve as a subject matter expert in complex insurance reimbursement, denial resolution, and payer adherence. The role handles high-dollar, aged accounts and advanced research to determine optimal resolution strategies.

You will identify systemic denial trends, perform root-cause analysis, and collaborate with RCM leadership to improve reimbursement, reduce denials, and maximize net collections.