Reimbursement Specialist
Core
Verify eligibility and benefits, collect clinical documentation, submit prior authorizations, negotiate payment rates, and process payer decisions for respiratory health products.
Role type
Reimbursement Specialist (Healthcare/Payer Operations)
Builds
Clean claims and revenue collection for respiratory health products
Domain
Healthcare / Insurance / Durable Medical Equipment
Deliverable
dashboards & analysis
Required skills
Eligibility verification, prior authorization submission, payment negotiation, clinical documentation assessment, payer policy knowledge, Microsoft Office proficiency
Preferred skills
Third party payer experience, Total Information Management System (TIMS) experience
Responsibilities
Verify eligibility and benefits to determine coverage; Gather clinical documentation to support medical necessity; Prepare and submit prior authorization requests; Process authorization decisions from payers; Negotiate payment rates for letters of agreement; Provide customer support regarding payer policies and coverage criteria.
Seniority
Mid-level, individual contributor