Reimbursement Specialist I

Reimbursement Specialist I (Secondary/Tertiary Claims)

Remote (Full Time)

Overview:

The Reimbursement Specialist I works secondary and tertiary dialysis claims after the primary payer has processed, reviewing EOBs, confirming COB/payer order, and taking the next correct action based on what the primary (and secondary) did. This role is phone- and portal-heavy and requires strong follow-through on aging/worklists, filing limits, underpayments, checks sent to patients, and accurate adjustments/write-offs to bring claims to zero. The team frequently works BCBS (multi-state) and government payers such as TRICARE/ChampVA/VA.

Essential Functions:

• Accurately collects revenue for assigned financial classes, including secondary and tertiary balances.
• Obtains and tracks claim status via phone and online portals for secondary/tertiary follow-up.
• Composes and follows up on claims appeals, including timely filing and COB-related issues.
• Identifies, addresses, submits, and processes adjustments and write-offs based on EOB review and payer outcomes.
• Reviews and understands Explanation of Benefits (EOBs) to reconcile primary-to-secondary/tertiary payment responsibility.
• Builds effective relationships with insurance carriers and representatives.
• Allocates coinsurance and deductibles within the applicable database.
• Reviews and addresses incoming mail correspondence.
• Communicates with patients regarding insurance checks.
• Completes and maintains facility reports on a regular basis and reviews for any issues.
• Maintains strict confidentiality of patient personal information and maintains HIPAA compliance.

Required Experience

• 0-2 years of experience as a Reimbursement Specialist, or equivalent work experience as an insurance collector.
• Proficiency in Microsoft Office Suite.
• Excellent customer service skills, demonstrated ability to actively contribute as a team player, and superior attention to detail.

Preferred Education & Experience:

• Bachelor's degree in business or healthcare management strongly preferred.
• Experience in dialysis and/or healthcare is preferred.
• Experience working secondary and/or tertiary claims and reviewing EOBs to resolve remaining balances.
• Experience with coordination of benefits (COB) and payer order research.
• Experience with government payers such as TRICARE, ChampVA, VA, and/or Medicare secondary/MSP.

At Innovative Renal Care (IRC), our comprehensive benefits program is a key component of our total compensation package. It includes a 401(k) match, healthcare coverage, and a broad range of other benefits that compare favorably within our industry and marketplace. Learn more atIRC Benefits and Perks

About Innovative Renal Care

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.

Our Values: I CARE

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.

Why Join IRC?

• Career Growth - Be part of a values-driven team making a meaningful impact.
• Competitive Compensation - Salaries continually benchmarked against market and trends.
• Enhanced PTO - Your most recent dialysis experience counts toward PTO accrual.
• Team Culture - Thrive in a supportive environment that values innovation, accountability, and compassion.

Innovative Renal Care is an equal opportunity and a drug free workplace.All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender identity, national origins, citizenship, disability or protected veteran status.All applicants will be subject to a drug screening and background check upon acceptance of an offer.

*IRC will only contact you from careers@innovativerenal.comor team members with an @innovativerenal.comemail address. Please be cautious and aware of spam or fraudulent emails soliciting personal or banking information. IRC will not request this information via email.

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