Reimbursement Specialist

3 weeks ago


Irvine, California, United States Hill-Rom Full time

Transforming Healthcare through Reimbursement Excellence

At Hill-Rom, we are committed to delivering exceptional patient care and outcomes. As a Reimbursement Specialist, you will play a critical role in ensuring that our products and services are accessible to those who need them most.

Your Key Responsibilities

  • Verify patient eligibility and benefits to determine coverage and payer requirements.
  • Ensure accurate benefit information is loaded to reduce rework and facilitate clean claims.
  • Gather clinical documentation to support medical necessity for our Respiratory Health products.
  • Assess clinical documentation to ensure compliance with applicable prescription, face-to-face, and coverage criteria requirements.
  • Prepare and submit prior authorization requests to insurance companies, including commercial payers and government payers.
  • Process authorization decisions from payers in a timely manner to streamline revenue.
  • Negotiate payment rates for letter of agreement to maximize collection potential.
  • Provide exceptional customer service by communicating payer policies, coverage criteria, benefit limitations, and product information to patients and healthcare teams.
  • Understand and adhere to all policies for Hill-Rom and third-party payers to ensure the highest standards of quality and compliance.
  • Contribute to team goals and understand how they support greater organizational objectives.

What We're Looking For

  • Associate's degree or higher preferred.
  • 3+ years of industry experience, preferably in health insurance and/or durable medical equipment.
  • Third-party payer experience strongly preferred.
  • Exceptional written, verbal, and interpersonal communication skills.
  • Strong critical thinking and problem-solving skills.
  • Detail-oriented and ability to multitask.
  • Ability to work independently and in a team environment.
  • Proficiency in Microsoft Office software.
  • Experience with Total Information Management System (TIMS) a plus.


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