Remote Medical Insurance Reimbursement Specialist

The Shared Services Center - Fort Smith provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. The Remote Insurance Reimbursement Specialist position is remote and full time, which is 40 hours per week. y employer.

As a Remote Insurance Reimbursement Specialist at Community Health Systems (CHS) - Patient Access Center, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental, and vision insurance, paid time off (PTO), 401(k) with company match, tuition reimbursement, and more

Job Summary 

The Remote Insurance Reimbursement Specialist is responsible for processing, reviewing, and verifying reimbursement claims to ensure accuracy, compliance, and timely resolution. This role involves analyzing account balances, identifying discrepancies, and applying appropriate transaction codes to facilitate accurate claims processing. The Reimbursement Specialist I collaborates with internal teams to support workflow efficiency, revenue integrity, and compliance with payer guidelines while maintaining productivity and accuracy standards. 

Essential Functions

• Processes and verifies reimbursement claims, ensuring accuracy and compliance with payer guidelines and regulatory requirements.
• Reviews and resolves claim discrepancies, identifying incorrect payments, denials, or underpayments and taking appropriate action.
• Applies correct transaction codes to accounts, ensuring proper claim adjudication and reimbursement flow.
• Monitors and follows up on outstanding claims, ensuring timely resolution and payment collection.
• Collaborates with revenue cycle teams and payers to investigate claim denials and appeal decisions when necessary.
• Researches and interprets payer policies, ensuring adherence to reimbursement requirements and claim submission rules.
• Documents account actions accurately and thoroughly in the appropriate systems, maintaining compliance with department protocols.
• Identifies process improvement opportunities, contributing to increased efficiency and streamlined reimbursement workflows.
• Maintains strict confidentiality of patient and financial information, ensuring compliance with HIPAA and corporate policies.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree or coursework in Accounting, Finance, Healthcare Administration, or related field preferred
• 0-1 years of experience in medical billing, reimbursement, claims processing, or accounts receivable required
• Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred

Knowledge, Skills and Abilities

• Strong knowledge of medical billing, reimbursement procedures, and payer guidelines.
• Familiarity with claim submission, denial management, and appeals processes.
• Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments.
• Proficiency in electronic health records (EH