Reimbursement Specialist I

Our culture and people are what set us apart from other post-acute care providers. We’re dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.

Schedule: Monday - Friday, 8:15am - 5:00pm in our office in Kettering OH

Location: In-office at our Kettering, OH location | Hybrid Model available based on productivity

The Reimbursement Specialist I is responsible for completing foundational reimbursement and collection activities to support timely and accurate payment for post-acute services. This role focuses on insurance eligibility verification, workflow management, claim rejection review, and early accounts receivable follow-up while maintaining accurate documentation and supporting efficient billing operations. The Reimbursement Specialist I works closely with internal teams and insurance payors and is expected to comply with all legal, Medicare, Medicaid, private insurance, and company rules and regulations.

Responsibilities:

• Verify insurance eligibility through workflow assignments and monthly eligibility processes for all payor types and accurately document findings within Homecare Homebase (HCHB)
• Manage assigned reimbursement workflows to support timely claim processing and payment resolution
• Review and respond to department emails and communications in a timely and professional manner
• Process and resolve MURTs in accordance with departmental standards and payer requirements
• Review and work claim rejections within the clearinghouse Inovalon to identify issues impacting reimbursement and facilitate timely resolution
• Perform accounts receivable follow-up activities as assigned to support prompt reimbursement and minimize outstanding balances
• Monitor and provide status updates for Medicare ADRs to ensure timely documentation submission and follow-up
• Identify missing or inaccurate information in Inovalon or HCHB affecting claim resolution
• Communicate accurately with teammates, patients, families, providers, vendors, and insurance payors regarding billing and reimbursement inquiries
• Escalate complex or unresolved billing issues and trends to leadership as appropriate to support timely payment and claims processing
• Maintain knowledge of agency policies, payer guidelines, legal requirements, and billing procedures
• Assist in identifying opportunities to improve reimbursement workflows and reduce claim delays or denials
• Promptly arrive at assigned location on scheduled workdays and work designated hours
• Attend in-services, educational programs, and meetings as necessary

QUALIFICATIONS:

Education/Experience: An Associate’s degree or equivalent collections experience is ideal. Healthcare experience is preferred.

Interpersonal Skills: Excellent oral and written communication skills.

Technical Skills: Computer proficiency is required. Experience with Excel and Outlook is preferred.

Miscellaneous Skills: Detail oriented with ability to manage multiple responsibilities and ability to prioritize responsibilities while still achieving collections goals.

• Any medical insurance experience, billing or authorization, in healthcare field is ideal.
• Excellent oral and written communication skills.
• Proficiency in Microsoft Excel, Word, and Outlook. Experience with an electronic medical record (EMR) is preferred.
• Quick learner with the ability to learn new software systems.
• Highly detail-oriented with strong organizational skills and the ability to manage and prioritize multiple tasks effectively.

We’ll help you put your passion for patient care to work. Apply today!

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

We are an Equal Opportunity Employer.