1,372 Reimbursement jobs in the United States

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
As a Collector, you play an integral role in delivering cost effective solutions for our patients by working with insurance companies to resolve issues associated with our patients' insurance claims.
In this role you will ensure timely follow-up on all patient accounts; including escalating payer trending concerns to leadership and timely communication with external departments; work with payers to ensure proper reimbursement on patient accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays); interface with insurance companies via phone and web portal to check claim status, submit written correspondence to payers and patients; interpret contracts with payers to ensure proper payment; send initial or secondary bills to insurance companies; process refunds and work to overturn insurance claim rejections while maintaining quality and productivity requirements.
To be successful in this role you will utilize Excel, Outlook, and Word and your critical thinking skills to ensure a high quality of work.
We offer instructor led training programs to set you up for success, in addition to a comprehensive benefits package that begins the first of the month after your start date and includes medical, dental and vision insurance as well as supplemental benefits, retail discounts and paid time off.
Additionally, we offer a flexible work schedule, starting your 8-hour day between 6:00am* and 9:30am ending your day by 6:00pm. *some locations require a 7:00am start time.
**Required Qualifications**
+ 1+ years of experience in a professional environment; beginner level experience working in Excel, Outlook, and Word.
**Preferred Qualifications**
+ Home infusion or durable medical equipment (DME) experience
+ Strong attention to detail with a sense of urgency
+ Customer service skills
+ Ability to work in a team environment
+ Experience with medical billing or collections or experience with accounts payable (AP) or accounts receivable (AR)
+ Experience with healthcare reimbursement systems.
**Education**
Verifiable High School Diploma or GED required.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$17.00 - $28.46
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
As a Medical Reimbursement Representative, you play an integral role in delivering cost effective solutions for our patients by working with insurance companies to resolve issues associated with our patients' insurance claims.
In this role you will ensure timely follow-up on all patient accounts; including escalating payer trending concerns to leadership and timely communication with external departments; work with payers to ensure proper reimbursement on patient accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays); interface with insurance companies via phone and web portal to check claim status, submit written correspondence to payers and patients; interpret contracts with payers to ensure proper payment; send initial or secondary bills to insurance companies; process refunds and work to overturn insurance claim rejections while maintaining quality and productivity requirements.
To be successful in this role you will utilize Excel, Outlook, and Word and your critical thinking skills to ensure a high quality of work.
We offer instructor led training programs to set you up for success, in addition to a comprehensive benefits package that begins the first of the month after your start date and includes medical, dental and vision insurance as well as supplemental benefits, retail discounts and paid time off.
Additionally, we offer a flexible work schedule, starting your 8-hour day between 6:00am* and 9:30am ending your day by 6:00pm. *some locations require a 7:00am start time
**Required Qualifications**
+ 1+ years of experience in a professional environment
+ Beginner level experience working in Excel, Outlook, and Word.
**Preferred Qualifications**
+ Home infusion or durable medical equipment (DME) experience
+ Strong attention to detail with a sense of urgency
+ Customer service skills
+ Ability to work in a team environment
+ Experience with medical billing or collections or experience with accounts payable (AP) or accounts receivable (AR)
+ Experience with healthcare reimbursement systems.
**Education:**
+ Verifiable High School Diploma or GED required.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$17.00 - $31.30
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
As a Medical Reimbursement Representative, you play an integral role in delivering cost effective solutions for our patients by working with insurance companies to resolve issues associated with our patients' insurance claims.
In this role you will ensure timely follow-up on all patient accounts; including escalating payer trending concerns to leadership and timely communication with external departments; work with payers to ensure proper reimbursement on patient accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays); interface with insurance companies via phone and web portal to check claim status, submit written correspondence to payers and patients; interpret contracts with payers to ensure proper payment; send initial or secondary bills to insurance companies; process refunds and work to overturn insurance claim rejections while maintaining quality and productivity requirements.
To be successful in this role you will utilize Excel, Outlook, and Word and your critical thinking skills to ensure a high quality of work.
We offer instructor led training programs to set you up for success, in addition to a comprehensive benefits package that begins the first of the month after your start date and includes medical, dental and vision insurance as well as supplemental benefits, retail discounts and paid time off.
Additionally, we offer a flexible work schedule, starting your 8-hour day between 6:00am* and 9:30am ending your day by 6:00pm. *some locations require a 7:00am start time
**Required Qualifications**
+ 1+ years of experience in a professional environment
+ Beginner level experience working in Excel, Outlook, and Word.
**Preferred Qualifications**
+ Home infusion or durable medical equipment (DME) experience
+ Strong attention to detail with a sense of urgency
+ Customer service skills
+ Ability to work in a team environment
+ Experience with medical billing or collections or experience with accounts payable (AP) or accounts receivable (AR)
+ Experience with healthcare reimbursement systems.
**Education:**
+ Verifiable High School Diploma or GED required.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$17.00 - $31.30
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
As a Medical Reimbursement Representative, you play an integral role in delivering cost effective solutions for our patients by working with insurance companies to resolve issues associated with our patients' insurance claims.
In this role you will ensure timely follow-up on all patient accounts; including escalating payer trending concerns to leadership and timely communication with external departments; work with payers to ensure proper reimbursement on patient accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays); interface with insurance companies via phone and web portal to check claim status, submit written correspondence to payers and patients; interpret contracts with payers to ensure proper payment; send initial or secondary bills to insurance companies; process refunds and work to overturn insurance claim rejections while maintaining quality and productivity requirements.
To be successful in this role you will utilize Excel, Outlook, and Word and your critical thinking skills to ensure a high quality of work.
We offer instructor led training programs to set you up for success, in addition to a comprehensive benefits package that begins the first of the month after your start date and includes medical, dental and vision insurance as well as supplemental benefits, retail discounts and paid time off.
Additionally, we offer a flexible work schedule, starting your 8-hour day between 6:00am* and 9:30am ending your day by 6:00pm. *some locations require a 7:00am start time
**Required Qualifications**
+ 1+ years of experience in a professional environment
+ Beginner level experience working in Excel, Outlook, and Word.
**Preferred Qualifications**
+ Home infusion or durable medical equipment (DME) experience
+ Strong attention to detail with a sense of urgency
+ Customer service skills
+ Ability to work in a team environment
+ Experience with medical billing or collections or experience with accounts payable (AP) or accounts receivable (AR)
+ Experience with healthcare reimbursement systems.
**Education:**
+ Verifiable High School Diploma or GED required.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$17.00 - $31.30
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
As a Medical Reimbursement Representative, you play an integral role in delivering cost effective solutions for our patients by working with insurance companies to resolve issues associated with our patients' insurance claims.
In this role you will ensure timely follow-up on all patient accounts; including escalating payer trending concerns to leadership and timely communication with external departments; work with payers to ensure proper reimbursement on patient accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays); interface with insurance companies via phone and web portal to check claim status, submit written correspondence to payers and patients; interpret contracts with payers to ensure proper payment; send initial or secondary bills to insurance companies; process refunds and work to overturn insurance claim rejections while maintaining quality and productivity requirements.
To be successful in this role you will utilize Excel, Outlook, and Word and your critical thinking skills to ensure a high quality of work.
We offer instructor led training programs to set you up for success, in addition to a comprehensive benefits package that begins the first of the month after your start date and includes medical, dental and vision insurance as well as supplemental benefits, retail discounts and paid time off.
Additionally, we offer a flexible work schedule, starting your 8-hour day between 6:00am* and 9:30am ending your day by 6:00pm. *some locations require a 7:00am start time
**Required Qualifications**
+ 1+ years of experience in a professional environment
+ Beginner level experience working in Excel, Outlook, and Word.
**Preferred Qualifications**
+ Home infusion or durable medical equipment (DME) experience
+ Strong attention to detail with a sense of urgency
+ Customer service skills
+ Ability to work in a team environment
+ Experience with medical billing or collections or experience with accounts payable (AP) or accounts receivable (AR)
+ Experience with healthcare reimbursement systems.
**Education:**
+ Verifiable High School Diploma or GED required.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$17.00 - $31.30
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
As a Medical Reimbursement Representative, you play an integral role in delivering cost effective solutions for our patients by working with insurance companies to resolve issues associated with our patients' insurance claims.
In this role you will ensure timely follow-up on all patient accounts; including escalating payer trending concerns to leadership and timely communication with external departments; work with payers to ensure proper reimbursement on patient accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays); interface with insurance companies via phone and web portal to check claim status, submit written correspondence to payers and patients; interpret contracts with payers to ensure proper payment; send initial or secondary bills to insurance companies; process refunds and work to overturn insurance claim rejections while maintaining quality and productivity requirements.
To be successful in this role you will utilize Excel, Outlook, and Word and your critical thinking skills to ensure a high quality of work.
We offer instructor led training programs to set you up for success, in addition to a comprehensive benefits package that begins the first of the month after your start date and includes medical, dental and vision insurance as well as supplemental benefits, retail discounts and paid time off.
Additionally, we offer a flexible work schedule, starting your 8-hour day between 6:00am* and 9:30am ending your day by 6:00pm. *some locations require a 7:00am start time
**Required Qualifications**
+ 1+ years of experience in a professional environment
+ Beginner level experience working in Excel, Outlook, and Word.
**Preferred Qualifications**
+ Home infusion or durable medical equipment (DME) experience
+ Strong attention to detail with a sense of urgency
+ Customer service skills
+ Ability to work in a team environment
+ Experience with medical billing or collections or experience with accounts payable (AP) or accounts receivable (AR)
+ Experience with healthcare reimbursement systems.
**Education:**
+ Verifiable High School Diploma or GED required.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$17.00 - $31.30
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Job Description

Job Description

Description:

Job Summary:

Charter Oak Health Center is seeking an Medical Reimbursement Specialist to join our team. In this role, you will be responsible for managing insurance balances. This includes following up with insurance companies and submitting appeals for any rejected or denied claims. The Specialist ensures that insurance claims are paid correctly to the organization. They manage outstanding accounts according to department standards, which may include maintaining a list of professional accounts, keeping track of payment agreements or reasons for unpaid balances, and making collection efforts. They also coordinate any adjustments, contractual allowances, or refunds as authorized. The Specialist identifies why claims are denied and stays updated on the specific policies and contracts of different insurers. An AR Denials Specialist at this level understands how to handle underpayments and credit balances effectively. This position offers an exciting opportunity to make a difference in the community while advancing your career in healthcare.

Essential Position Duties

• Identifies root causes behind insurance denials and keeps up to date with payer policies, contracts, and bulletins.
• Shares information on trends related to payer denials for specific procedures or diagnosis codes with management.
• Resolves insurance balances accurately after payments are made. This includes identifying any patient costs and ensuring accounts are correctly settled according to payment terms.
• Follows up with payers to make sure outstanding claims are resolved quickly by using phone calls, emails, faxes, or websites.
• Uses both internal and external resources to analyze patient accounts and takes action to resolve payment issues. Documents all activities according to organizational and payer policies.
• Submits Letters of Medical Necessity (LOMN) with appeals for claims that were rejected or denied.
• Continue to check accounts and escalate issues if a denial is not overturned.
• Works with the Patient Access, Medical Coding Coordinator, Patient Service Representative, and Eligibility Coordinators to resolve denials related to medical necessity, eligibility, referrals, or authorization.
• Sets follow-up actions based on how the claims are progressing and ensures clear documentation in the system.
• Works with team members on special projects to achieve timely deliverables - and communicates results effectively, while also completing other assigned tasks.

Compliance Responsibilities

• Complies with applicable legal requirements, standards, policies, and procedures, including but not limited to those within the Compliance Process, Code of Conduct, HIPAA, and Corporate Integrity Agreement (CIA).
• Participates in required orientation and training programs, as required.
• Reports concerns and suspected incidences of non-compliance in accordance with COHC Compliance Reporting Process.
• Cooperates with monitoring and audit functions and investigations.
• Participates, as requested, in process improvement responsibilities.

Requirements:

Professional Experience/Educational Requirements

• High School Diploma/GED or minimum of 2 years direct experience with an Associate or Bachelor’s degree from an accredited program
• Minimum of 3 years’ Billing experience required in healthcare Rev Cycle with specialization in billing, account receivable follow-up, and denial management
• Two years of accounting experience, and strong knowledge of accounting theory and methods.

Certification/Licensure

• Certified Medical Biller/not required
• Certified Revenue Cycle Specialist/not required

CCA-Claims
**_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time._**
**Position Summary:**
Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the end-to-end review, analysis, and resolution of complex reimbursement issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and provider engagement initiatives. This role also provides support in managing provider disputes and escalations requiring detailed pricing and reimbursement validation.
**Supervision Exercised:**
+ No, this position does not have direct reports.
**Essential Duties & Responsibilities:**
+ Analyze MassHealth and Medicare claim reimbursements to ensure compliance with contractual terms, state and federal regulations, and internal payment policies.
+ Resolve provider inquiries and disputes related to pricing discrepancies, contract interpretation, and fee schedule issues.
+ Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate and resolve reimbursement concerns.
+ Conduct retrospective audits to identify systemic payment issues and recommend resolution pathways.
+ Interpret and apply MassHealth fee schedules, All-Payer Rate Setting regulations, and CMS payment methodologies (e.g., DRG, APC, RBRVS).
+ Support provider appeal reviews and internal payment integrity investigations by providing reimbursement validation.
+ Escalate systemic or high-impact discrepancies to the Director of Claims Operations and Quality Assurance for further investigation or configuration updates.
+ Document all research, findings, and outcomes in claims systems (e.g., Salesforce, Facets) in compliance with audit standards and MassHealth requirements.
+ Maintain awareness of MassHealth transmittals, billing guides, and program updates to ensure adherence in payment practices.
+ Ensure SLA compliance for inquiry resolution, appeal response times, and post-payment audits.
+ Assist in the resolution of complex provider disputes and escalations, including direct support to leadership in pricing determinations and dispute case documentation.
**Working Conditions:**
+ Standard office conditions.
**Required Education (must have):**
+ N/A
**Desired Education (nice to have):**
+ Associate's or Bachelor's degree in Health Administration, Finance, or related field preferred.
+ Certified Professional Coder (CPC) - AAPC
+ Certified Claims Professional (CCP)
+ Other AHIMA or Medicaid billing-related certifications
**Required Experience (must have):**
+ 3+ years in healthcare claims processing, provider reimbursement, or payment integrity.
+ Experience with core claims platforms such as Facets, QNXT, or Amisys.
**Desired Experience (nice to have):**
+ Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly preferred.
**Required Knowledge, Skills & Abilities (must have):**
+ Proficiency with Excel and reporting tools for data analysis.
+ Understanding of provider contracts, rate tables, and state-set payment methodologies.
+ Strong problem-solving and analytical skills.
+ Effective verbal and written communication with both internal stakeholders and providers.
+ Meticulous attention to detail and documentation standards.
**Required Language (must have):**
+ English
**Desired Knowledge, Skills, Abilities & Language (nice to have):**
+ **Knowledge of Facets, MassHealth, and CMS is a plus.**
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.

JOB SUMMARY:
Under the direction of PFS Leadership, the Reimbursement Specialist I is responsible for billing and collections of outstanding account balances for commercial, government, and managed care payors as assigned. The Reimbursement Specialist I is required to identify and report payor issues to their leadership. It is a requirement for the Reimbursement Specialist I to read, interpret and apply complex payor contract language to expected reimbursement calculations and pursue all payments due to the organization. The Reimbursement Specialist I must perform account collection activities utilizing internet resources and professional telephone communication etiquette. The Reimbursement Specialist I is required to compose professional written correspondence with all internal and external entities. This position expects the Reimbursement Specialist I to demonstrate organization and time management skills to manage account collections.
MINIMUM QUALIFICATIONS:
HS Diploma, GED or Equivalent
2 Years of Experience
Proficient in Microsoft Excel, Word and Outlook programs
PREFERRED QUALIFICATIONS:
Associate's degree
3 Years of Experience
**The current salary range for this position is $21.00 to $28.88**
Rady Children's Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the "date posted" until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.
EOE including disability/vet