State Licensed Senior Reimbursement Specialist

Job Summary

Seeking a State Licensed Senior Reimbursement Specialist to work remotely in a full-time role, where the specialist will manage complex pre- and post-service appeals, mentor junior team members, and drive process improvements to enhance revenue capture across the revenue cycle.

Key responsibilities

• Independently manage complex pre- and post-service appeals, including Level 1, Level 2, and external review pathways
• Serve as a clinical subject matter expert on payer medical policies, guiding appeal strategy for high-dollar cases
• Mentor Clinical Reimbursement Specialists, providing case review and coaching on payer policy interpretation

Required qualifications

• Active clinical licensure (e.g., RN, NP)
• Associate or Bachelor's degree in nursing
• 3-5 years of experience in healthcare reimbursement or revenue cycle operations
• 2+ years of experience in prior authorization, denial management, or appeals
• Advanced understanding of payer medical policies and appeals processes