Reimbursement Specialist III

Другое

• Company is a unified cloud suite of medical office software hosted on Amazon Web Services/AWS including practice management, electronic health records, and patient engagement, and offers managed medical billing services for independent practices. Company serves an expansive national footprint of 65,000 practitioners across 14,000 practices and 900 independent medical billing companies. 8.8M insurance claims are processed every month on the  Company billing platform!
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• Are you an experienced medical billing leader with a passion for resolving complex claims and optimizing reimbursement outcomes? Do you thrive on mentoring others while driving measurable results for client accounts? If so, we invite you to apply for our Reimbursement Specialist III (Medical Billing) Team Lead position!
• At Company, headquartered in South Jordan, UT, we are seeking a seasoned Reimbursement Specialist III  as a revenue cycle professional to join our growing team as a subject matter expert in medical billing and Company workflows. In this critical role, you will manage complex insurance accounts receivable, resolve escalated denials, and partner with clients and internal teams to improve reimbursement outcomes. You'll also provide guidance to team members, identify reimbursement trends, and support leadership initiatives to drive operational excellence across the department.
• This is an exciting opportunity to join a healthcare technology leader where your expertise will directly shape client satisfaction, team performance, and financial outcomes. If you're ready to take ownership of complex reimbursement processes, mentor a team, and collaborate with a high-performing group, we want to hear from you.
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• Correct claims prior to submission by identifying and resolving edits that may result in denials, rejections, or reimbursement delays
• Review, analyze, and resolve denied and rejected claims identified through payer correspondence, software work queues, clearinghouse reports, and EOBs
• Perform follow-up on unpaid and aged accounts receivable using a systematic aging approach to achieve final claim resolution
• Research and resolve complex reimbursement issues, underpayments, and payer discrepancies
• Submit appeals and supporting documentation as required to secure appropriate reimbursement
• Communicate payer requirements, policy updates, and reimbursement changes to clients and leadership
• Proactively assist clients in identifying claim-edit opportunities to prevent future denials and improve clean claim rates
• Maintain effective and proactive communication with clients regarding account status, reimbursement issues, and resolution strategies to prevent escalations
• Serve as a trusted resource and revenue cycle advisor for assigned client accounts
• Track accounts receivable performance, progress, and profitability for assigned client accounts
• Identify, analyze, and communicate reimbursement trends impacting client financial performance
• Monitor and report payer trends, denial patterns, and reimbursement opportunities
• Recommend corrective actions and process improvements to improve collection rates and reduce aging
• Mentor, train, and support Reimbursement Specialists and other team members in reimbursement processes and payer-specific requirements
• Assist Supervisors with training initiatives, workflow management, quality improvement efforts, and special projects
• Serve as a subject matter expert for complex account resolution and reimbursement questions
• Maintain accurate client master file records and ensure data integrity within all applicable systems
• Participate in testing, implementation, and optimization of workflow improvements and system enhancements
• What You'll Need to Get the Job Done :
• High School Diploma or GED required
• 5+ years of medical billing, accounts receivable, collections, or revenue cycle management experience
• Demonstrated expertise in denial management, claims follow-up, and reimbursement resolution
• Advanced understanding of payer requirements and medical billing regulations
• Experience working with multiple payer types, including Commercial, Medicare, Medicaid, and Managed Care organizations
• Advanced proficiency with practice management and billing systems
• Strong analytical, problem-solving, and organizational skills
• Excellent written, verbal, and interpersonal communication skills
• Company software experience preferred
• Experience mentoring, training, or leading team members preferred
• You're highly motivated and self-driven, with a track record of driving results in complex accounts
• You have a positive attitude (training, resiliency, appreciate the growth from adversity)
• You are highly team oriented and focus on the success of your peers and mentees as well as yourself
• Proven track record of writing compelling appeals with favorable outcomes on complex, high-dollar claims
• Excellent communication and organizational skills with a customer service focus
• Ability to prioritize competing demands while maintaining productivity and accuracy
• Advanced knowledge of medical billing, reimbursement processes, and accounts receivable management
• Ability to interpret EOBs, remittance advice, payer bulletins, and reimbursement guidelines
• Knowledge of healthcare compliance regulations, including HIPAA
• Strong client relationship management and conflict resolution skills
• A natural mentor who enjoys developing the skills of others
• Self-starter with the ability to organize work for maximum efficiency and attention to quality
• Ability to grasp new concepts and procedures quickly, with a desire to lead others through change
• Life at Company: The BURST Way to Be - Learn more about our Company culture.
• Be Intentional – We act with clarity, focus, and purpose in everything we do.
• Urgency with Purpose – We move fast on what matters and deliver meaningful results.
• Respect Always – We lead with integrity, value every voice, and build each other up.
• Strive for Greatness – We set high standards, embrace innovation, and never stop improving.
• Together with Clients – We collaborate deeply, build trusted partnerships, and win as one team.
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• About Company    
• Company, now part of the Francisco Partners (“FP”) portfolio, revolutionized medical office software in 1999 with the introduction of the industry’s first true cloud solution. Today, the company continues to lead HealthTech innovation with a complete cloud suite of smart applications that work in unison, accelerating collaborative workflow for every role of the practice. With Company, medical office staff are empowered to thrive in the online age of healthcare and value-based reimbursement with essential clinical, financial, patient engagement and reputation management applications that are unified and available anytime, anywhere on any device. Company strives to be the technology heartbeat of healthcare for providers, patients, and payors for a healthier world. For more informati
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• Hybrid office arrangement in the South Jordan, Utah office location. In Office training, with opportunity to work up to a flexible hybrid format. Remote work is contingent upon individual role, team structure and alignment to role KPIs.