Senior Reimbursement Specialist — Healthcare Claims

Alura Workforce Solutions; Laguna Hills (CA); Presencial; USD 45.000 - 50.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Benefits package with medical, dental,

Vision coverage

401k program

PTO and sick leave

Growth opportunities

Team events

Casual Fridays

Descripción de la vacante

Alura Workforce Solutions seeks a Reimbursement Specialist llI (Home Infusion/Specialty Pharmacy Claims) to join our Laguna Hills, CA team. You will optimize claim submissions, appeals, and interactions with payers to maximize reimbursement while maintaining compliance.

The role requires hands-on medical collections experience, knowledge of ICD-10/CPT/HCPCS, and proficiency with CPR+ or CareTend. Monday–Friday on-site; $33–$36 per hour DOE with full benefits.

Formación

• 3+ years of hands-on medical collections and reimbursement experience.
• In-depth knowledge of managed care, commercial insurance, ICD-10, CPT, HCPC codes, J billing codes, and CMS HCFA 1500 forms & Electronic Billing.
• Experience with Benefit Investigation and Patient Responsibility Agreements.
• Experience with automated billing systems, CPR+ is preferred.
• Advanced proficiency in Microsoft Word, Excel, and Outlook.

Responsabilidades

• Reviews patient inventory of assigned accounts.
• Collects on all open AR inventory to ensure reimbursements are received within 30-45 days of billed date.
• Work on all correspondences assigned before due dates.
• Correlating insurance coverage with services to be provided.
• Initiate Single Case Agreements (SCA) when claims are short paid.
• Preparation and review of insurance claims.
• Review payer contracts and fee schedules to verify that received payments match agreed rates.
• In-depth understanding of healthcare billing and coding processes.
• Navigate complicated insurance policies and regulations.
• Evaluates payments received to ensure that reimbursement received is accurate.
• Maintains a positive DSO on assigned account inventory.
• Provides the highest level of customer service in answering patient phone calls and resolve patients’ questions and/or billing issues, as well as communicate with doctors’ offices and their staff.
• Assists in account collections activities as needed.
• Ensures compliance with all payer rules, regulations along with company policies & procedures.
• Monitor patient account inventories and process all assigned correspondence before due dates.
• Additional duties and responsibilities in different areas of the department on an as-need basis or determined by management.

Conocimientos

Medical collections

Reimbursement experience

Managed care knowledge

ICD-10

CPT

HCPCS codes

CMS 1500 forms

CPR+ experience

Microsoft Word

Microsoft Excel

Outlook

Herramientas

CareTend

Descripción del empleo

Alura Workforce Solutions seeks a Reimbursement Specialist llI (Home Infusion/Specialty Pharmacy Claims) to join our Laguna Hills, CA team. You will optimize claim submissions, appeals, and interactions with payers to maximize reimbursement while maintaining compliance.

The role requires hands-on medical collections experience, knowledge of ICD-10/CPT/HCPCS, and proficiency with CPR+ or CareTend. Monday–Friday on-site; $33–$36 per hour DOE with full benefits.