Remote Healthcare Reimbursement Specialist – Nationwide – Maximize Revenue Integrity

Join a forward‑thinking revenue cycle team that empowers you to optimize claim accuracy and accelerate reimbursements—all from the comfort of your home office. At Apex Health Solutions, your expertise directly fuels financial health for providers across the country.

About the Role

As a Healthcare Reimbursement Specialist, you will be the linchpin between clinical documentation and payer reimbursement. You’ll analyze complex claim data, identify denial trends, and collaborate with coding, compliance, and clinical teams to ensure every service is captured accurately and paid promptly. This fully remote position offers the autonomy to manage your workflow while contributing to a high‑impact, mission‑driven organization.

Key Responsibilities

• Review and validate inpatient, outpatient, and professional claims for coding accuracy, medical necessity, and payer‑specific rules.
• Conduct root‑cause analysis on denials and underpayments; develop corrective action plans that reduce denial rates by ≥15 % within the first year.
• Maintain up‑to‑date knowledge of CMS, Medicaid, and commercial payer policies; translate regulatory changes into actionable workflow updates.
• Partner with CDI specialists and physicians to improve documentation specificity, supporting higher RVU capture and compliant billing.
• Generate monthly reimbursement dashboards and present findings to leadership, highlighting revenue leakage and recovery opportunities.
• Participate in cross‑functional projects such as EHR optimization, payer contract negotiations, and value‑based care model alignment.

Requirements

• Bachelor’s degree in Health Information Management, Finance, Business Administration, or related field (or equivalent experience).
• Minimum 3 years of hands‑on experience in healthcare reimbursement, denial management, or revenue cycle operations.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Revenue Cycle Representative (CRCR) strongly preferred.
• Proficiency with major EHR platforms (Epic, Cerner, Meditech) and claims editing tools (Change Healthcare, Availity, Waystar).
• Advanced Excel skills (pivot tables, VLOOKUP/XLOOKUP, Power Query) and experience with data visualization tools (Tableau, Power BI).
• Exceptional analytical mindset, attention to detail, and ability to communicate complex findings to both technical and non‑technical audiences.

Preferred Qualifications

• Experience with value‑based reimbursement models (MIPS, APMs, bundled payments).
• Background in managed care contracting or payer relations.
• Familiarity with robotic process automation (RPA) for claim scrubbing workflows.

Salary Range

$55,000 – $78,000 USD per year, commensurate with experience, certifications, and geographic differentials. This range reflects current market data for fully remote reimbursement specialists across the United States.

Benefits

• 100 % remote work environment with a generous home‑office stipend ($1,200 annually).
• Comprehensive health, dental, and vision plans effective day one.
• 401(k) with 4 % company match and immediate vesting.
• Annual continuing‑education allowance ($2,500) for certifications, conferences, and courses.
• Flexible PTO policy plus 10 paid holidays and a dedicated “Recharge Week” each year.
• Wellness program including mental‑health resources, fitness reimbursements, and virtual community events.

Why Join Apex Health Solutions?

We believe that accurate reimbursement is the backbone of sustainable healthcare. Our culture prizes transparency, continuous learning, and measurable impact. You’ll work alongside a collaborative team of revenue cycle veterans, data scientists, and clinical partners who share a commitment to reducing administrative waste and improving patient access. Your contributions will be visible in real‑time dashboards, quarterly revenue reports, and the satisfaction of providers who can focus on care instead of collections.

How to Apply

Submit your resume and a concise cover letter outlining your denial‑reduction achievements and certification status through our careers portal. Applications are reviewed on a rolling basis, and we encourage early submission to ensure consideration for the upcoming cohort.