Reimbursement Specialist

Position Summary

Advanced Rx Management, a rapidly growing pharmaceutical services company headquartered in Sunrise, Florida, is seeking a results-driven Reimbursement Specialist to support our expanding national client base.

This role is responsible for managing the full revenue cycle for Workers' Compensation and Personal Injury prescription claims, with direct accountability for reducing Accounts Receivable and driving timely, accurate reimbursement. The selected candidate will own a defined book of business and be responsible for resolving claims efficiently, minimizing AR aging, identifying denial trends, and improving overall cash flow performance.

The ideal candidate is analytical, detail-oriented, and proactive, with the ability to think critically through complex billing issues, identify root causes of denials or underpayments, and strategically move accounts toward resolution.

Key Responsibilities

• Manage the full billing and collections lifecycle for a defined book of Workers' Compensation and Personal Injury prescription claims, with direct accountability for AR performance and aging metrics
• Maintain and thoroughly work a minimum of 40+ patient accounts, ensuring consistent progress toward resolution
• Review and prioritize aging reports daily to proactively reduce 60/90/120+ day AR and accelerate reimbursement
• Analyze EOBs, notices of disallowance, state fee schedule variances, and payment discrepancies to identify root causes and independently execute the appropriate resolution strategy (corrected claim submission, appeal, adjuster outreach, escalation, or legal follow-up)
• Track and resolve unpaid and underpaid claims to ensure accurate reimbursement in accordance with contractual terms and state fee schedules
• Prepare and submit timely, comprehensive appeals with complete medical and billing documentation to support dispute resolution
• Ensure claim accuracy through detailed review and correction of demographic information, insurance data, ICD-10 diagnoses, CPT coding, and billing modifiers as needed
• Identify denial patterns and recurring payer issues; recommend and support process improvements to reduce repeat denials and strengthen revenue cycle performance
• Maintain detailed, accurate account documentation to support compliance, reporting, and effective follow-up
• Communicate professionally and persistently with insurance carriers, adjusters, attorneys, and internal clinical teams to drive timely account resolution
• Meet or exceed defined KPIs related to AR reduction targets, collection rate improvement, appeal success rates, productivity standards, and quality and accuracy benchmarks
• Support special projects and revenue cycle improvement initiatives aligned with company growth objectives

Qualifications

• Minimum 2 years of medical billing and collections experience (preferred)
• Workers' Compensation billing experience strongly preferred
• Strong knowledge of EOB interpretation, understand ICD-10 coding, and denial management
• Proven experience with appeals and insurance carrier follow-up
• Strong analytical and problem-solving skills
• High attention to detail and ability to manage multiple accounts simultaneously
• Excellent written and verbal communication skills
• Proficient in Microsoft Excel
• Ability to work independently in a fast-paced, growth-oriented environment

Ideal Candidate Profile

• Critical thinking beyond task execution
• Ownership of account resolution
• Persistence in follow-up and escalation
• Ability to identify patterns and recommend process improvements
• Professionalism in communication with payers and legal entities