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_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 (EHR), billing software, and reimbursement systems._

+ _Strong problem-solving and critical-thinking skills, ensuring accurate claims resolution._

+ _Effective communication and collaboration skills, working with payers, revenue cycle teams, and internal departments._

+ _Knowledge of HIPAA, compliance regulations, and healthcare reimbursement standards._

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

_This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer._

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.