Reimbursement Specialist - Collections

The Reimbursement Specialist is accountable for performing all Collections efforts for all Accounts Receivable (AR). The primary goal for this position is to ensure that all Collections functions are performed timely, accurately and in adherence to Pentec Healths compliance program.

Essential Duties & Responsibilities:

  • Manage assigned accounts, ensuring Accounts Receivables are resolved within 90 days, which includes resolving issues as needed.
  • Build and maintain relationships with payor representatives.
  • Resubmit corrected, accurate and timely Clean Claims for the required invoice type (CMS 1500, 835 Electronic Medical Claims, and NCPDP 5.1 Pharmacy).
  • Identify and resolve global issues that create denials or un-responded claims.
  • Verify accuracy of charges.
  • Correct errors in accounts, as needed.
  • Address claims for appeal process.
  • Correct patient bills for copays and deductibles as appropriate.
  • Process refund requests, invoices, statements and collection letters
  • Maintain correct patient records and documentation of all correspondence and status.
  • Protect patient confidentiality, according to HIPAA guidelines.

Non Essential Duties and Responsibilities

  • Perform filing duties accurately and timely.
  • Respond to correspondence.
  • Generate reports from CPR+ or other report generation software.
  • Complete miscellaneous clerical duties.
  • Investigate complaints.
  • Respond to customer questions timely and accurately.

Skills, Competencies and Experience:


  • Troubleshooting: ability to anticipate issues, research and implement creative solutions.
  • Problem-solving: solutions/results oriented, clear communication, communicates a sense of authority through subject matter expertise, resourcefulness
  • Professionalism and tact
  • Negotiation
  • Business Relationship Building: customer service orientation, respectful speaking manner, conveyance of empathy, effective listening, relation to all staff levels
  • Team-oriented, dependable
  • Knowledge of claim and benefit requirements for Medicare, Medicaid, HMO, PPO and/or other third party payors.
  • Ability to calculate drug dispensed based on prescription/order correctly.
  • Ability to calculate figures and amounts correctly, such as interest and percentages.
  • Ability to investigate issues with invoices and confer with internal and external parties to resolve discrepancies.
  • Education of drug types and treatments, so as to resolve issues effectively while maintaining business relationships
  • Clear, effective oral Communication of the American English language, both face-to-face and telephone
  • Adherence to deadlines


  • Self-motivated
  • Proficiency with Microsoft Office, Outlook
  • Strong organization
  • Strong under pressure, can continue working amidst stressful environment
  • Knowledge of specialty infusion/ renal dialysis
  • Personable, gets along with diverse individuals and teams

Education, Certifications, Trainings:


  • 3+ years of experience in medical billing, accounts receivable, intake or Bachelors degree in Healthcare Administration or business-related field


  • Proficiency with Keyboarding on both PC and laptop
  • Proficiency, daily use with Microsoft Excel
  • Proficiency, daily use with Microsoft Word
  • Proficiency, daily use with CPR+ or similar platform

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