Reimbursement Specialist - Healthcare

About the role

Join a fast-paced revenue cycle team where you’ll take the lead in resolving complex insurance claims, driving timely reimbursements, and making a direct impact on financial performance and operational success.

Responsibilities

• Manage denied and rejected insurance claims by researching root causes, correcting claim issues, and following up with payers to secure timely reimbursement.
• Review EOBs, payment variances, aging reports, and negative balances to ensure accurate claim processing.
• Work directly with insurance payers to resolve denials, authorization issues, filing errors, and reimbursement discrepancies.
• Escalate recurring payer trends and recommend process improvements or solutions to leadership.
• Verify patient eligibility and benefits, including qualifying diagnoses, prior testing, and authorization requirements.
• Interpret insurance benefits and claim outcomes to support accurate billing and reimbursement.
• Utilize Excel, dashboards, and daily/weekly worklists to track claims activity, monitor productivity, and identify reimbursement trends.
• Maintain compliance with internal processes, reimbursement standards, and quality expectations.
• Support team collaboration by assisting with payer resolution efforts across accounts and ensuring timely follow-up on insurance correspondence and outstanding claims.

Requirements

• 2+ years of experience in Accounts Receivable Management, Reimbursement, Collections, or Denial Management.
• Hands-on experience resolving denied and rejected insurance claims and working directly with payers.
• Bachelor’s degree, High School Diploma or GED, or vocational training in finance, accounting, business administration, economics, or a related field.
• Ability to successfully perform the following minimum Physical, Cognitive and Environmental job requirements with or without accommodation.

Skills

• Strong denial management and claims troubleshooting abilities.
• Knowledge of insurance payers, including Medicare, Medicaid, Blue Cross Blue Shield, and commercial plans.
• Proficiency in Excel, dashboards, and analyzing payer trends/worklists.
• Ability to verify insurance benefits and interpret EOBs (Explanation of Benefits).
• Strong computer skills with the ability to navigate multiple systems efficiently.
• Analytical and detail-oriented professional with strong problem-solving and communication skills.
• Thrives working independently in a fast-paced environment while maintaining a collaborative and adaptable team-focused mindset.

Schedule

• Office-based role requiring full-time presence in the company’s facilities.
• In-person work at least 3 days per week.

Pay

The pay range for this position in Chicago, IL and Malvern, PA is $26.00 to $41.00 per hour. The actual base pay offered may vary within the posted ranges depending on job-related knowledge/skills, experience, business needs, geographical location, and internal equity. In addition, other compensation such as an annual incentive bonus, sales commission, or long-term incentives may be offered.

Benefits

• Comprehensive Philips Total Rewards benefits program.
• Generous PTO.
• 401k with up to 7% match.
• HSA with company contribution.
• Stock purchase plan.
• Education reimbursement.

About Philips

We are a health technology company built around the belief that every human matters, and we won't stop until everybody everywhere has access to the quality healthcare that we all deserve. Learn more about our business, rich history, purpose, and culture.

US work authorization is a precondition of employment. The company will not consider candidates who require sponsorship for a work-authorized visa, now or in the future. For this position, you must reside in or within commuting distance to Chicago, IL or Malvern, PA.