• Reimbursement Specialist - Third-Party Collections

    Job Locations US-MA-Wellesley
  • Overview

    HealthDrive is currently seeking a full-time Reimbursement Specialist at our corporate headquarters in Wellesley, MA.  We offer a comprehensive benefits package and a business casual environment conveniently located on Route 9 East.

    • Do you have experience in appealing and resolving unpaid medical claims from Medicare, MA Medicaid and plans including: AARP, Aetna, Cigna, BC/BS, Evercare, Fallon, Harvard Pilgrim, Tufts, United Healthcare and numerous other managed care plans?
    • Are you able to quickly identify denial or nonpayment trends and conduct the required research to resolve the issues in a timely manner?  Do you have extensive knowledge of insurance carrier guidelines related to physician claims? 
    • Can you review and take the actions required to obtain payment or resolve the outstanding balance on a minimum of 60 charges a day? 


    HealthDrive delivers on-site dentistry, optometry, podiatry and audiology to residents in long-term care, skilled nursing and assisted living facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence. 


    Included, but not limited to:


    • Identify, investigate and follow up with insurance plans to expedite resolution of denied and/or unpaid claims in order to obtain payment in a timely manner
    • Submit corrected claims and appeals in a timely manner within insurance plan timely filing/appeal deadlines
    • Become the expert on the billing and claim requirements for assigned insurance plans
    • Utilize insurance plan website (s) to check claim status, submit online appeals, submit EOB documents required for processing secondary/tertiary claims and review the online provider manuals for requirements regarding services provided by HealthDrive.
    • Identify and communicate denial trends by insurance plan, reviews and resolves denials by reason code
    • Reduce outstanding A/R and DSO by increasing cash collections on a monthly basis
    • Meet daily productivity objectives for review and resolution of assigned accounts (minimum daily productivity goals are assigned)
    • Identify rate variances by procedure code by insurance plan against expected payment rates, research variances and communicate findings to Manager
    • Document all conversations with patients, facilities, insurance plans regarding a specific patient in the patient record and all actions taken to resolve outstanding balances in patient record
    • Initiate claim adjustments and resubmission of claims to the insurance carrier, intermediary, facility or other responsible party
    • Work professionally and cooperatively with facilities, responsible parties, insurance carriers and all internal and external customers
    • Assists with back-up phone coverage duties for Billing Customer Service phone queue
    • Assists with other duties and/or projects in order to meet business needs / objectives


    • Prior experience in collecting accounts receivable from Medicare, Medicaid, Managed Care plans or commercial insurance carriers in a healthcare related environment
    • Prefer experience in large volume multispecialty physician practice or hospital setting for Audiology, Dental, Optometry or Podiatry services
    • Excellent attention to detail, with strong analytical skills, and possess excellent communication skills both verbal and written
    • Highly organized and have the ability to work in a fast-paced environment, with the ability to work effectively and efficiently with both custom and “off the shelf” computer applications
    • Self-motivated with the ability to work well independently and as part of a team environment with minimal direct supervision
    • Strong Microsoft Office application skills in Excel, Outlook and Word
    • Proven track record in successfully managing assigned healthcare accounts receivable portfolio and achieving monthly cash, DSO and bad debt objective
    • Associate’s degree and/or equivalent work experience and minimum of 5 years' experience in 3rd party medical billing and collection.


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