Medical Reimbursement Specialist

The Medical Reimbursement Specialist is responsible for reviewing clinical documentation, billing and coding, assigning accurate diagnosis and procedure codes, preparing and submitting insurance claims, resolving claim denials, and supporting timely reimbursement. This position requires exceptional attention to detail, working knowledge of medical terminology and coding systems, and the ability to communicate effectively with providers, insurance carriers, patients, and internal team members while maintaining compliance with HIPAA, payer requirements, and applicable regulatory standards.

Position Title: Medical Reimbursement Specialist

Reports To: Lead Clinician, Office Manager

Employment Type: Part-time; on-site, remote, or hybrid depending on organizational needs

Job Summary

The Medical Reimbursement Specialist is responsible for reviewing clinical documentation, billing and coding, assigning accurate diagnosis and procedure codes, preparing and submitting insurance claims, resolving claim denials, and supporting timely reimbursement. This position requires exceptional attention to detail, working knowledge of medical terminology and coding systems, and the ability to communicate effectively with providers, insurance carriers, patients, and internal team members while maintaining compliance with HIPAA, payer requirements, and applicable regulatory standards.

Essential Duties and Responsibilities

·      Review provider documentation, patient encounters, laboratory reports, and operative notes to confirm completeness, accuracy, and coding readiness.

·      Assign appropriate ICD-10-CM, CPT, and HCPCS codes for diagnoses, procedures, supplies, and services in accordance with current coding guidelines.

·      Prepare, review, and submit accurate claims to insurance payers electronically or through designated payer portals.

·      Verify patient insurance eligibility, benefits, coverage limitations, referrals, and prior authorization requirements.

·      Monitor unpaid, denied, rejected, or underpaid claims and initiate timely corrective action to support reimbursement.

·      Communicate professionally with providers, clinical staff, insurance representatives, and patients to resolve coding, billing, and payment-related matters.

·      Post payments, review explanations of benefits, and reconcile patient accounts as assigned.

·      Maintain accurate billing records and documentation within the electronic health record or practice management system.

·      Support compliance with HIPAA, CMS requirements, payer regulations, organizational policies, and established coding standards.

·      Participate in audits, claim reviews, and process improvement initiatives designed to strengthen revenue cycle performance.

Required Qualifications

·      High school diploma or equivalent required; associate degree or certificate in medical billing, coding, health information management, or a related field preferred.

·      Demonstrated knowledge of ICD-10-CM, CPT, HCPCS, medical terminology, anatomy, and healthcare reimbursement processes.

·      Experience with electronic health record systems, practice management software, clearinghouses, and payer portals preferred.

·      Professional certification such as CPC, CPC-A, CBCS, CCS, CCA, or a comparable credential preferred or required based on organizational needs.

·      Previous experience in medical billing, coding, claims processing, insurance verification, or revenue cycle operations preferred.

Required Skills and Competencies

·      Excellent accuracy, organization, and attention to detail.

·      Ability to interpret clinical documentation and apply coding guidelines appropriately and consistently.

·      Strong written and verbal communication skills.

·      Ability to manage deadlines, prioritize responsibilities, and follow up consistently on outstanding claims.

·      Sound problem-solving skills for researching claim denials, payer requirements, and account discrepancies.

·      Commitment to confidentiality, compliance, and ethical billing practices.

·      Proficiency with Microsoft Office applications and standard data entry functions.

Work Environment

This position is generally performed in a healthcare office, outpatient clinic, billing department, third-party billing organization, or approved remote work environment. The role requires extended periods of computer use, frequent professional communication by telephone and email, and ongoing collaboration with clinical and administrative team members.

Administrative & Care Coordination

·      Schedule patient appointments, wellness programs, and follow-up visits in a timely and organized manner.

·      Verify insurance coverage, assist with prior authorizations, process referrals, and coordinate care with providers and specialists.

·      Respond to telephone calls, patient portal messages, and email communications in a courteous, timely, and professional manner.

·      Maintain accurate records, manage clinical supply inventory, and support efficient daily clinic operations.

Ideal Candidate

·      Demonstrates a strong commitment to preventive care, nutrition, and whole-person wellness.

·      Maintains a compassionate, patient-centered, positive, and professional approach.

·      Is comfortable educating, encouraging, and building trust with patients managing chronic conditions.

·      Is organized, detail-oriented, and capable of managing multiple priorities in a fast-paced clinical setting.

·      Works collaboratively, demonstrates reliability, and is motivated to grow with a mission-driven team.

Benefits

·      Competitive hourly compensation

·      Strong potential for transition to a full-time position

·      Paid training and orientation

·      Continuing education opportunities

·      Supportive, mission-driven work environment

·      Opportunity for professional growth within an innovative wellness practice

Equal Opportunity Statement

We are an equal opportunity employer and consider qualified applicants without regard to race, color, religion, sex, national origin, disability, veteran status, or any other status protected by applicable law.

Tapestry Wellness Institute is a mission-driven wellness practice that believes food is medicine. We help clients manage diabetes, heart disease, obesity, hypertension, and other chronic conditions through medical nutrition therapy, diabetes care and education support, lifestyle medicine, wellness assessments, and long-term coaching. Tapestry Wellness is a company emerging to lead and provide progressive, quality patient-centered care with noteworthy investments in our area community organizations, healthcare providers, doctors, nurses and staff united to support underserved communities and promote technological advancements in diabetes treatment. Tapestry Wellness is an American Diabetes Association (ADA) recognized Diabetes Self-Management and Education Support health clinic and is licensed with the Feinstein Institutes for Medical Research of Northwell Health, New York. As a consulting partner with South Carolina Department of Public Health Diabetes and Heart Disease Management division, Tapestry Wellness offers the DECIDETM self-management support program designed to improve chronic disease outcomes in high-risk and underserved populations. Tapestry Wellness liaises with physicians and allied healthcare providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.