Remote Healthcare Reimbursement Specialist – Nationwide – Join a Growing HealthTech Team

We are seeking a detail‑oriented Healthcare Reimbursement Specialist to optimize claims processing, maximize reimbursement, and ensure compliance across a nationwide remote workforce. This role offers the chance to impact revenue cycle performance while collaborating with clinicians, payers and technology teams from the comfort of your home office.</payers, and IT in a fast‑growing health‑services environment.

About the Role

As a Remote Healthcare Reimbursement Specialist, you will own the end‑to‑end reimbursement lifecycle for a diverse portfolio of medical services. You will analyze claim denials, work closely with billing teams to resolve issues, and implement process improvements that reduce days in accounts receivable. Your expertise will help the organization maintain regulatory adherence, improve cash flow, and support strategic growth initiatives across multiple states.

Key Responsibilities

• Review, submit, and follow up on medical claims to private insurers, Medicare, and Medicaid, ensuring accurate coding and timely reimbursement.
• Investigate and appeal denied or underpaid claims, preparing supporting documentation and communicating with payer representatives.
• Monitor key performance indicators such as claim acceptance rate, denial rate, and days sales outstanding, reporting trends to management.
• Collaborate with clinical and coding staff to capture charge information correctly and provide training on documentation best practices.
• Stay current with federal and state reimbursement regulations, payer policy changes, and industry coding updates (ICD‑10, CPT, HCPCS).
• Assist in the configuration and testing of reimbursement modules within the organization’s practice management and EHR systems.
• Prepare monthly reimbursement forecasts and variance analyses to support budgeting and financial planning efforts.

Requirements

• Minimum of 2 years of experience in medical billing, claims adjudication, or healthcare reimbursement.
• Strong knowledge of CPT, ICD‑10, and HCPCS coding guidelines, as well as payer-specific billing rules.
• Proficiency with practice management software, electronic health records (EHR), and clearinghouse platforms (e.g., Availity, Waystar).
• Excellent analytical skills with the ability to interpret remittance advice, identify root causes of denials, and develop corrective action plans.
• Effective written and verbal communication abilities for interacting with providers, payers, and internal stakeholders.
• Self‑motivated, detail‑oriented, and capable of managing multiple priorities in a remote work setting.
• High school diploma or equivalent; associate’s degree in health information management, finance, or related field preferred.

Preferred Qualifications

• Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) credential.
• Experience working with value‑based care models, bundled payments, or accountable care organization (ACO) reimbursement structures.
• Familiarity with healthcare compliance frameworks such as HIPAA, Stark Law, and the Anti‑Kickback Statute.
• Background in process improvement methodologies (Lean, Six Sigma) applied to revenue cycle operations.
• Knowledge of SQL or basic data querying to extract claims data for analysis.

Benefits

• Competitive salary with annual performance bonuses.
• Comprehensive health, dental, and vision insurance plans.
• 401(k) retirement plan with company match.
• Generous paid time off, including holidays and sick leave.
• Professional development stipend for certifications, conferences, and continuing education.
• Flexible remote work schedule with optional hybrid office days.
• Employee assistance program and wellness resources.
• Opportunity to contribute to mission‑driven projects that improve patient access to care.

Salary Range

$48,000 – $68,000 USD per year (commensurate with experience and certifications).