Senior Reimbursement Specialist

Job Summary

A company is looking for a Senior Specialist, Reimbursement Operations.

Key Responsibilities

• Support reimbursement inquiries by providing accurate coding, coverage, and payment guidance
• Conduct in-depth research on coding, payer policies, and regulatory updates to resolve reimbursement questions
• Manage Coding Hotline inquiries and collaborate with providers to resolve claim issues

Required Qualifications

• Bachelor's degree and minimum 2 years of relevant experience, or Associate's degree and minimum 6 years of relevant experience, or High school diploma/equivalent and minimum 8 years of relevant experience
• Extensive experience providing coding, coverage, and payment guidance in a healthcare environment
• Experience supporting prior authorization, denials, and appeals processes
• Comprehensive knowledge of medical coding guidelines and ability to review operative reports and rejected claims
• Knowledge of Medicare, Medicare Advantage, Medigap, and commercial payer methodologies