Remote Healthcare Reimbursement Specialist – Nationwide – Unlock Your Impact in Revenue Cycle

Join a forward‑thinking team that turns complex claim data into clean revenue for top‑tier health systems. Work from anywhere while mastering payer policies, denial management, and compliance strategies that keep providers financially healthy.

About the Role

As a Healthcare Reimbursement Specialist you will be the linchpin between clinical operations and financial performance. You’ll analyze explanation of benefits (EOBs), identify underpayments, and collaborate with coding, billing, and clinical documentation improvement (CDI) teams to ensure every service is reimbursed accurately and promptly. This fully remote position offers the autonomy to design your workflow while accessing cutting‑edge revenue‑cycle technology and a supportive virtual community.

Key Responsibilities

• Review and reconcile commercial, Medicare, and Medicaid remittances for multiple provider groups.
• Investigate and appeal denied or underpaid claims using payer‑specific guidelines and regulatory updates.
• Partner with coding specialists to validate CPT, HCPCS, and ICD‑10‑CM accuracy before submission.
• Develop and maintain payer contract matrices, fee schedules, and reimbursement benchmarks.
• Generate monthly KPI dashboards (denial rate, days in A/R, net collection %) for leadership review.
• Lead process‑improvement projects that reduce rework and accelerate cash flow.

Qualifications & Requirements

Education & Certifications

• Bachelor’s degree in Health Information Management, Finance, Business Administration, or related field.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Revenue Cycle Representative (CRCR) strongly preferred.

Experience

• Minimum 3 years hands‑on experience in hospital or large‑group practice reimbursement.
• Proven track record reducing denial rates by ≥15% within 12 months.
• Deep familiarity with major payer portals (Availity, Change Healthcare, NaviNet) and EHR systems (Epic, Cerner, Meditech).

Technical Skills

• Advanced Excel (pivot tables, VLOOKUP/XLOOKUP, Power Query) and data‑visualization tools (Tableau, Power BI).
• SQL basics for ad‑hoc claim data extraction.
• Experience with robotic process automation (RPA) or claim‑scrubbing software a plus.

Preferred Skills

• Knowledge of value‑based reimbursement models (MIPS, APMs, bundled payments).
• Familiarity with HIPAA, Stark Law, and Anti‑Kickback Statute compliance.
• Strong written communication for crafting persuasive appeal letters and policy briefs.

Salary Range

$55,000 – $78,000 USD per year, commensurate with experience, certifications, and geographic cost‑of‑living adjustments.

Benefits & Perks

• 100% remote work with a $1,200 annual home‑office stipend.
• Comprehensive medical, dental, and vision plans (employer pays 85%).
• 401(k) with 4% company match, immediate vesting.
• Generous PTO (15 days + 10 holidays) plus a “Recharge Week” after every 12 months.
• Continuing‑education allowance ($2,500/year) for certifications, conferences, and courses.
• Quarterly virtual team‑building events and an annual in‑person summit (travel covered).

Company Culture

Our organization thrives on transparency, data‑driven decision‑making, and a “patient‑first” mindset that extends to our employees. We celebrate diverse perspectives, encourage experimentation, and reward outcomes over hours logged. Weekly stand‑ups, monthly “Revenue Cycle Roundtables,” and an open‑door Slack channel keep everyone aligned and engaged, no matter the time zone.

How to Succeed in This Role

• Stay current on CMS rule changes and payer policy bulletins; allocate 30 minutes daily for regulatory scanning.
• Build a personal library of appeal templates tailored to the top five denial reasons you encounter.
• Leverage automation for repetitive claim‑status checks, freeing time for high‑value analysis.
• Communicate proactively with clinical partners—schedule brief huddles before major coding updates.
• Track your personal KPI dashboard; aim for a 10% quarter‑over‑quarter improvement in net collections.