Senior Reimbursement Specialist – Order Entry

Senior Reimbursement Specialist – Order Entry

Requirements

• 3–6 years of recent experience in high-volume professional and/or facility billing and reimbursement, with demonstrated expertise in order entry and claims submission processes.
• Proven ability to handle complex payer issues, front-end rejections, and escalated reimbursement inquiries with minimal oversight.
• Strong proficiency in billing platforms and payer portals; experience with laboratory billing systems such as Xifin is highly preferred.
• Strong experience with Salesforce or similar CRM.
• High level of comfort with Excel and Microsoft Office Suite; ability to analyze data and create process reports or summaries as needed.
• Strong knowledge of national and regional payer requirements and healthcare billing regulations.
• Excellent written and verbal communication skills, with the ability to interact effectively with internal teams and external partners.
• Demonstrated ability to work both independently and collaboratively to meet deadlines and exceed performance targets.
• High school diploma or equivalent required; additional coursework or certifications in medical billing, coding, or revenue cycle operations a plus.

Responsibilities

• Lead and execute the accurate entry of incoming demographics into the billing tool and ensure timely, clean claims submissions using the HCFA 1500 form or electronic equivalent.
• Serve as a primary escalation point for complex or high-priority claims issues and front-end denials, working directly with payer portals to troubleshoot and resolve issues efficiently.
• Perform comprehensive eligibility verification and coordination of benefits to ensure claims accuracy prior to submission.
• Maintain a high level of accuracy in data entry and account notations across multiple billing systems.
• Provide expert-level reimbursement guidance and support to patients, demonstrating empathy, professionalism, and superior customer service.
• Collaborate with cross-functional teams to support initiatives related to payer engagement, claim edits, and process improvements.
• Ensure full compliance with HIPAA and all applicable regulatory standards; manage medical record requests for patients, payers, and providers as needed.
• Identify opportunities for operational efficiencies and contribute to the development and refinement of SOPs and best practices.
• Support training, mentoring, and knowledge sharing among junior team members.
• Participate in audits and other special projects as assigned.

Preferred Qualifications

• Experience with laboratory billing systems such as Xifin is highly preferred.