What are the responsibilities and job description for the Reimbursement Specialist position at Advanced Solution?
Position Summary
The Claims Reimbursement Specialist will be essential in driving the market adoption and insurance coverage of Omeza Complete Matrix, an innovative wound care biologic. This role serves as the subject-matter expert for medical billing, coding, prior authorizations, and claims reimbursement, ensuring that healthcare providers and patients receive timely, accurate support in navigating complex payer requirements.
The ideal candidate will have a strong background in healthcare revenue cycle management, with deep knowledge of Medicare, Medicaid, and commercial insurance policies specific to wound care and biologic products. Acting as a central liaison between providers, payers, and internal teams, this individual will streamline reimbursement processes, resolve claims issues, and provide education on proper billing and coding practices.
Key Responsibilities
Claims Support & Processing
Assist providers and office staff with claims submissions for Omeza Complete Matrix.
Ensure accuracy of CPT/HCPCS codes, ICD-10 codes, and modifiers to minimize denials and delays.
Track, monitor, and follow up on outstanding claims and resubmissions.
Insurance & Payer Communication
Engage directly with insurance companies, Medicare/Medicaid representatives, and third-party administrators to verify coverage and resolve reimbursement barriers.
Assist in prior authorization and appeals processes for denied claims.
Education & Training
Provide billing and coding education to providers, clinics, and distributors on best practices for Omeza Complete Matrix.
Develop and maintain reimbursement resource materials, including coding guides and coverage policy summaries.
Compliance & Documentation
Maintain compliance with HIPAA and all payer-specific billing regulations.
Accurately document all provider and payer interactions in the company CRM or reimbursement system.
Stay updated on payer policy changes, coverage determinations, and healthcare reimbursement regulations affecting wound care biologics.
Cross-Functional Collaboration
Partner with sales, market access, and customer support teams to ensure a seamless provider and patient experience.
Provide reimbursement insights and trends to leadership to inform strategy and payer engagement.
Qualifications
Education & Certification
Associate or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Biller (CPB) strongly preferred.
Experience
3 years of experience in medical billing, coding, and insurance reimbursement, preferably within biologics, wound care, medical devices, or specialty pharmaceuticals.
In-depth knowledge of CPT, HCPCS, and ICD-10 coding systems.
Experience with payer portals, EOBs, prior authorizations, and appeals processes.
Familiarity with Medicare/Medicaid coverage processes and private payer policy navigation.
Skills
Strong written and verbal communication skills with providers and payers.
Ability to manage multiple reimbursement cases simultaneously with accuracy.
Proficiency with billing software, EMRs, and Microsoft Office Suite.
Strong problem-solving and resolution-oriented mindset.
