Reimbursement Specialist II

AdvancedMD

AdvancedMD is a unified cloud suite of medical office software hosted on Amazon Web Services/AWS including practice management, electronic health records, and patient engagement, and offers managed medical billing services for independent practices. AdvancedMD serves an expansive national footprint of 65,000 practitioners across 14,000 practices and 900 independent medical billing companies. 8.8M insurance claims are processed every month on the AdvancedMD billing platform!

Role Summary
Are you a detail-oriented medical billing professional with a passion for resolving claims and optimizing reimbursement processes? Do you thrive in a fast-paced environment where your analytical skills and client communication make a measurable impact? If so, we invite you to apply for our Reimbursement Specialist 2 position!

At AdvancedMD, headquartered in South Jordan, UT, we are seeking a proactive and experienced reimbursement expert to join our growing team. In this critical role, you will manage the full lifecycle of medical claims—from pre-submission edits to denial resolution—while identifying payer trends and driving improvements in client account performance. These team members work directly with clients to identify, prioritize and manage strategic needs for an efficient service workflow for optimal A/R outcomes. Reimbursement Specialists will manage a broad array of projects in relation to claims resolution, including payer tracking, website access, claims status inquiries, and direct carrier contact.

This is an exciting opportunity to join a healthcare technology leader where your expertise will directly support client satisfaction and financial outcomes. If you're ready to take ownership of reimbursement processes and collaborate with a high-performing team, we want to hear from you.

Essential Job Duties:

• Correct claims pre-submission for identified edits that will result in a claim denial or delay

• Follow up on denied and rejected claims as identified through carrier denials/rejections via software or EOBs

• Follow up on unpaid claims in an aged approach for final claim resolution

• Communicate payer requirements or updates to clients and leadership

• Proactively assist clients in identifying specific claim edits to avoid future claim denials

• Communicate effectively and proactively with clients to avoid escalation

• Track A/R progress and profitability of client accounts

• Identify and analyze reimbursement trends within the client office key

• Identify and communicate payer trends

Qualifications:

• 3+years of medical billing experience

• Knowledge of Medicare, Medicaid and commercial payors claims and appeals processing requirements

• Intermediate knowledge of ICD, CPT and HCPCS coding, ability to ready EOB and ERA files

• General understanding of CCI edits and carrier specific coding edits

• Strong working knowledge of Windows, MS Word, Internet Explorer, Excel, , and Outlook

• Must have a good understanding of the Medical Billing Process and Industry Standards

• Ability to manage and fulfill client expectations independently by managing client questions, processes and escalations

• Excellent written and oral communication skills

What Will Make us LOVE You

• You’re highly motivated and self-driven

• You have a positive attitude (training, resiliency, appreciate the growth from adversity)

• You are highly team oriented and focus on the success of your peers as well as yourself

• Proven track record or writing compelling appeals with favorable outcomes

• Excellent communication and organizational skills with a customer service focus

• Ability to prioritize effectively and handle shifting priorities professionally

• Knowledge of medical computerized billing and scheduling software systems

• Ability to communicate with various business contacts in a professional and courteous manner

• Self-starter with the ability to organize work for maximum efficiency and attention to quality

• Proven ability to meet deadlines in a fast-paced environment

• Ability to grasp new concepts and procedures quickly, with a desire to learn

Are you FIT? Learn more about our Company culture

• Flexible. Vibrant, collaborative & diverse culture that is open-minded & embraces change.

• Insightful. Innovative industry experts who transform client businesses by delivering winning outcomes.

• Trusted. Experienced, reliable & accountable advocates with unwavering integrity.

About AdvancedMD

AdvancedMD, now part of the Francisco Partners (“FP”) portfolio, revolutionized medical office software in 1999 with the introduction of the industry’s first true cloud solution. Today, the company continues to lead HealthTech innovation with a complete cloud suite of smart applications that work in unison, accelerating collaborative workflow for every role of the practice. With AdvancedMD, medical office staff are empowered to thrive in the online age of healthcare and value-based reimbursement with essential clinical, financial, patient engagement and reputation management applications that are unified and available anytime, anywhere on any device. AdvancedMD strives to be the technology heartbeat of healthcare for providers, patients, and payors for a healthier world. For more information on AdvancedMD, please visit www.advancedmd.com.

Work Environment

• Hybrid office arrangement to start in the South Jordan, Utah office location, with option to work remotely available. Remote work is contingent upon individual role, team structure and alignment to role KPIs.

What We Offer:

•
Competitive compensation and total rewards benefits

•
Comprehensive health, dental, and vision insurance

•
401(k) with generous company match

•
Paid time off and holidays

•
Hybrid and remote work opportunities

•
Career growth and development support

•
Collaborative, team-oriented culture

Privacy Notices for Team Members and Job Applicants