Job Grade:

Level 1: (min is 14.50, max is 18.10)

Position Summary

The Reimbursement Specialist is an entry level role responsible for early-stage follow-up on Workers’ Compensation claims. This includes verifying claim status, resubmitting original bills, initiating basic appeals, and updating documentation. While you will not handle complex denials, underpayments, or escalations, your role plays a key part in driving provider cash flow and laying the foundation for claim resolution. You will work across multiple systems (OutSystems Portal, Invoice Maintenance, Lookup, Smeadlink, etc.) to manage a portfolio of accounts, while following UHS protocols and maintain professional communication with payers and internal teams.

Key Responsibilities

• Verify claim receipt and processing status of bills and appeals via direct communication to insurance carriers, employers, state agencies, attorneys, patients, and other third-party entities.
• Utilize various payer, state, client and clearinghouse applications to obtain and validate status.
• Validate payer bill-to information. Resubmit invoices and appeal packets using correct billing formats and supporting documentation.
• Apply strong analytical thinking and sound decision-making skills when handling correspondence with payers, employers, patients, and clients to resolve workers’ compensation claims.
• Accurately document call activity, status changes, and payer communication for continued follow-up and resolution efforts.
• Escalate claims outside normal scope (e.g., complex denials or underpayments) to senior staff or appropriate departments.
• Use UHS systems to research and update claim details, attach documents, and monitor worklists.
• Follow standardized workflows to ensure compliance with UHS policies and state regulations.
• Communicate professionally via phone and email with payers and internal departments.
• Maintain assigned performance metrics and department initiatives.
• Uphold UHS Pact and comply with HIPAA and all applicable privacy regulations.

The Reimbursement Specialist role is dynamic and may include additional tasks related to collections and revenue cycle support as needed. All duties should be performed in accordance with UHS policies, payer guidelines, and relevant state/federal regulations.

Required Qualifications & Skills

• High school diploma. College degree is not required, but some college preferred.
• Experience in call centers or client-facing healthcare roles is beneficial.
• Strong communication skills, both written and verbal, with the ability to communicate clearly with healthcare providers, patients, and insurance representatives.
• Strong analytical skills with attention to detail; able to review claim data and determine next steps.
• Highly organized and able to manage account portfolios, prioritize tasks, and meet goals in a fast-paced environment.
• Ability to work independently while meeting goals and performance metrics. Reliable time management and organizational skills.
• Flexible and adaptable to ongoing changes within the organization and industry.
• Proficiency in Microsoft Office and comfortable navigating multiple tools simultaneously.

Preferred Qualifications

• Basic understanding of healthcare revenue cycle operations, including billing and insurance follow-up workflows and claim terminology.
• Knowledge of billing software, EMRs, or claims tools; experience with clearinghouses or payer portals is helpful.