About the Role
Title: Reimbursement, Reimbursement Specialist (Claim Denial & Appeal Focus)
Location: Remote US
46,000.00-47,277.00 per year Hourly + Bonus
Full Time
Excellent Benefits with Castle paying approximately 94% of medical insurance premium, Company HSA contribution, 30 paid days off a year (includes 10 holidays), 6%-401K match with no vesting schedule.
Job Description:
- Annual salary ranging from $46,000 to $47,277, depending on qualifications and experience
- Competitive base pay plus up to 20% performance-based bonus
- 20 days of earned PTO each year in addition to 10 paid holidays
- 401(k) plan with full company matching up to 6%
- Choice of three healthcare plans along with employer HSA contributions
- Company stock awarded at the time of hiring
A DAY IN THE LIFE OF A Reimbursement Specialist (Claim Denial & Appeal Focus)
In this role, you will manage and resolve denied insurance claims related to laboratory services. Responsibilities include gathering and submitting required documentation to insurance providers, initiating appeals on behalf of patients, and tracking outstanding claims until resolution.
A large part of the job involves reviewing claims for errors before submission to ensure accuracy and timeliness. You will analyze Explanation of Benefits (EOBs), electronic remittance advice, and denial notices, assign appropriate ANSI codes, and take corrective actions within the billing system.
You will also communicate directly with insurance companies to obtain missing details or updates, use payer portals for follow-ups, and submit additional documentation when needed. Crafting both standard and customized appeal letters is a key part of the role, ensuring arguments are aligned with payer policies or applicable regulations. Appeals may be submitted to Medicare, Medicare Advantage, and commercial insurance providers.
Qualifications
- High school diploma, GED, or equivalent professional experience
- Minimum of two years’ experience in health insurance billing, particularly with lab-related claims
- Familiarity with payer requirements, including authorized representative forms
- Ability to manage a high daily workload (35+ claims per day)
- Typing speed of at least 35 WPM with 90% or better accuracy
Work Schedule
- Monday through Friday, 8:00 AM to 5:00 PM
- Non-exempt position
- Fully remote, with work conducted from a home office within the United States
