JOB SUMMARY

The Remote Insurance Reimbursement Specialist is responsible for processing, reviewing, and verifying reimbursement claims to ensure accuracy, compliance, and timely resolution. This role involves analyzing account balances, identifying discrepancies, and applying appropriate transaction codes to facilitate accurate claims processing. The Reimbursement Specialist I collaborates with internal teams to support workflow efficiency, revenue integrity, and compliance with payer guidelines while maintaining productivity and accuracy standards.

QUALIFICATIONS

• H.S. Diploma or GED required
• Associate Degree or coursework in Accounting, Finance, Healthcare Administration, or related field preferred
• 0-1 years of experience in medical billing, reimbursement, claims processing, or accounts receivable required
• Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred

KNOWLEDGE, SKILLS AND ABILITIES

• Strong knowledge of medical billing, reimbursement procedures, and payer guidelines.
• Familiarity with claim submission, denial management, and appeals processes.
• Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments.
• Proficiency in electronic health records (EHR), billing software, and reimbursement systems.
• Strong problem-solving and critical-thinking skills, ensuring accurate claims resolution.
• Effective communication and collaboration skills, working with payers, revenue cycle teams, and internal departments.
• Knowledge of HIPAA, compliance regulations, and healthcare reimbursement standards.
  We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.
  Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
  This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer

• Processes and verifies reimbursement claims, ensuring accuracy and compliance with payer guidelines and regulatory requirements.
• Reviews and resolves claim discrepancies, identifying incorrect payments, denials, or underpayments and taking appropriate action.
• Applies correct transaction codes to accounts, ensuring proper claim adjudication and reimbursement flow.
• Monitors and follows up on outstanding claims, ensuring timely resolution and payment collection.
• Collaborates with revenue cycle teams and payers to investigate claim denials and appeal decisions when necessary.
• Researches and interprets payer policies, ensuring adherence to reimbursement requirements and claim submission rules.
• Documents account actions accurately and thoroughly in the appropriate systems, maintaining compliance with department protocols.
• Identifies process improvement opportunities, contributing to increased efficiency and streamlined reimbursement workflows.
• Maintains strict confidentiality of patient and financial information, ensuring compliance with HIPAA and corporate policies.
• Performs other duties as assigned.
• Complies with all policies and standards.