Reimbursement Specialist

Job Function Summary
Comfort Medical, a wholly owned subsidiary of Coloplast, is seeking a Reimbursement Specialist to join our team. This role is responsible for ensuring the timely and accurate resolution of accounts receivable through effective claims processing, cash collections, and appropriate write-offs. The ideal candidate will demonstrate a strong understanding of medical billing, insurance verification, and payment posting. They will be capable of independently investigating and correcting claim denials, resubmitting claims, and processing appeals. This position requires a high level of attention to detail, excellent organizational skills, and the ability to collaborate across departments.

Major Areas of Accountability

• Review, correct, and process claims for all payers, both electronically and manually
• Investigate and resolve claim denials, making corrections as needed
• Apply accurate contractual adjustments to resolve outstanding balances
• Respond to billing inquiries from patients and insurance representatives professionally and promptly
• Reconcile patient collections and deposits
• Identify and report denial trends; propose solutions to reduce future denials
• Process refund requests and ensure compliance with payer guidelines
• Maintain accurate and detailed documentation within patient account
• Process appeals, including online and paper submissions
• Submit outstanding accounts receivable daily per company protocol
• Work claims exceptions (ERL rejections) through the clearinghouse each day
• Interpret Accounts Receivable and apply correct adjustments in accordance with accounting principles
• Provide outstanding service to patients, internal teams, and third-party payers
• Review and resolve aged held billing issues (e.g., sales orders not auto-confirming due to errors)
• Collaborate effectively across departments to gather and share necessary data
• Adapt to changes in a fast-paced, evolving work environment
• Position may require occasional cross-departmental support, including insurance verification and payment posting
• Comply with all HIPAA, legal, and ethical standards, including Advanced Code of Ethics
• Coloplast employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.
• Occasionally, employees currently recognized as high performers through recent performance evaluations, or employees with current demonstrated productivity leadership compared to other employees on existing metrics may be asked to engage in overtime. (Major job functions)
• Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.
• Other job duties as assigned

Basic Qualifications

• High school diploma or equivalent
• Minimum of 3 years' experience in collections
• At least 1 year of experience in healthcare billing, insurance verification, or government medical programs (DME experience preferred)
• Strong knowledge of medical terminology and healthcare reimbursement processes
• Proficiency in reading and interpreting claim rejections and EOBs (Explanation of Benefits)
• Solid negotiation skills and proven track record in collections (Minimum qualifications of experience, degrees, etc.)

Preferred Qualifications

• Experience in DME (Durable Medical Equipment) billing and collections
• Bilingual in Spanish and English
• Brightree Software

At Coloplast, we believe in recognizing and rewarding the contributions of our employees. Our total rewards package is designed to support your well-being, foster your professional growth, and ensure a healthy work-life balance. Here is some of what you can expect:

• Health and Wellness:Comprehensive medical, dental, and vision insurance plans to keep you and your family healthy. Plus, access to company sponsored wellness programs and mental health resources, paid leave of absence for qualifying events and generous paid parental leave for both birthing and non-birthing parents.
• Financial Security:A competitive 401(k) plan with company match that vest immediately, financial planning services to help you secure your future, and corporate discount programs for goods and services.
• Work-Life Balance:Generous paid time off, flexible work hours, and flexible work arrangement options to help you balance your personal and professional life may be available.
• Professional Development:Opportunities for continuous learning and career advancement through training programs, mentorship, and tuition reimbursement.
• Recognition and Rewards:Recognition programs to celebrate achievements and contributions, including peer recognition, bonuses, awards, and special events.
• Community and Culture:A supportive work environment where everyone feels valued, and has a sense of belonging. Participate in team-building activities, volunteer opportunities, and company-sponsored events. Sustainability strategy that outlines our ambitions for how to run our company in a more sustainable way.
• Competitive Compensation:The starting hourly rate for this position is $23.53. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives.Actual compensation is influenced by a variety of factors including but not limited to skills, experience, qualifications, and geographic location.

Comfort Medical provides an extensive selection of name brand catheter and ostomy supplies to thousands of customers nationwide. Our attention to detail, unmatched customer service, and dedication to helping our customers live happier, healthier lives are just a few of the many reasons we are one of the fastest growing catheter and ostomy supply companies in the nation!

Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.

Comfort Medical is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification.

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