[Hiring] Reimbursement Specialist @Innovative Renal Care

Role Description

The Reimbursement Specialist manages post‑adjudication claim balances for an assigned group of payers. This role focuses on resolving unpaid claims, remaining balances, and claim follow‑up with government and commercial payers. This role ensures accurate and timely collection of health insurance payments by coordinating with payer representatives, documenting claim activity, and resolving outstanding balances in accordance with organizational policies and applicable federal, state, and local regulations.

• Manage and collect post‑adjudication claim balances for assigned dialysis facilities, including unpaid and underpaid claims.
• Conduct claim follow‑up with Medicare, Veterans Affairs, TRICARE, Medicaid, and commercial payers through portals, phone outreach, and electronic systems.
• Review and interpret EOBs and remittance advice to determine next steps for remaining balances and payer discrepancies.
• Prepare and submit appeals, reconsiderations, adjustments, and corrections related to outstanding claim balances.
• Resolve payer correspondence and address issues identified through incoming mail, reports, and system alerts.
• Allocate coinsurance, deductibles, and patient responsibility accurately within the applicable database.
• Communicate professionally with patients and collaborate with internal departments to support timely balance resolution.

Qualifications

• Bachelor’s degree in business or healthcare management strongly preferred.
• 4-5 years in medical claims collections, payer follow‑up, or healthcare reimbursement.
• Experience in dialysis, nephrology, or ESRD claims strongly preferred.
• Strong knowledge of Medicare, VA, TRICARE, and other government payer processes.
• Proficiency in Microsoft Office Suite and healthcare billing platforms.
• Excellent communication, problem‑solving, and customer service skills.
• Ability to work independently in a remote environment with high accuracy and attention to detail.

Benefits

• Comprehensive benefits program, including a 401(k) match and healthcare coverage.
• Broad range of other benefits that compare favorably within the industry and marketplace.

Company Description

We are one of the largest dialysis service providers in the U.S., partnering with local physicians to deliver high-quality care to patients with ESRD and other kidney conditions. Our mission is to be the trusted experts and preferred partners for patients, physicians, and healthcare providers by delivering best-in-class care, service, and solutions.

• Integrity & Innovation – Earn trust by keeping promises and embracing new solutions.
• Compassion – Treat patients, families, and colleagues with respect and empathy.
• Accountability – Take ownership and recognize the contributions of others.
• Results-Driven – Strive for excellence and exceed expectations.
• Everyone Counts – Foster diversity, equity, teamwork, and collaboration.