What Does a Reimbursement Specialist Do?
A reimbursement specialist ensures that healthcare providers are paid accurately and on time by managing insurance claims, billing processes, and payment follow-ups. They verify patient insurance coverage, submit claims to payers, resolve claim denials, and track outstanding balances. Their work helps healthcare organizations maintain financial stability while ensuring patients understand their billing responsibilities.
Reimbursement specialists work closely with patients, insurance companies, and internal teams such as billing, coding, and revenue cycle management. They need strong knowledge of healthcare reimbursement systems, insurance regulations, and compliance standards. This role is critical to minimizing claim rejections, maximizing reimbursement, and supporting overall healthcare operations.
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Reimbursement Specialist Core Responsibilities
- Verify patient insurance eligibility and coverage prior to services
- Prepare, submit, and track insurance claims for reimbursement
- Review and correct billing errors to reduce claim denials
- Follow up with insurance companies on unpaid or denied claims
- Communicate with patients regarding billing inquiries and payment options
- Ensure compliance with federal, state, and payer-specific regulations
- Collaborate with billing and coding staff to streamline revenue cycle processes
- Maintain accurate records of claims, payments, and denials
Required Skills and Qualifications
Hard skills
- Proficiency in medical billing, coding, and reimbursement processes
- Knowledge of CPT, ICD-10, and HCPCS coding systems
- Familiarity with electronic health records (EHR) and billing software
- Ability to analyze and resolve insurance claim denials
- Understanding of Medicare, Medicaid, and commercial insurance policies
Soft skills
- Strong attention to detail and accuracy in financial transactions
- Effective written and verbal communication skills
- Problem-solving and conflict-resolution abilities
- Ability to work independently and manage multiple claims
- Customer service skills for patient interactions
Education
- High school diploma or GED required
- Associate’s or bachelor’s degree in healthcare administration, business, or related field preferred
Certifications
- Certified Reimbursement Specialist (CRS) preferred
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) valued
Preferred Qualifications
- 2+ years of experience in medical billing, insurance claims, or revenue cycle management
- Experience with payer portals and claim tracking systems
- Familiarity with HIPAA compliance and healthcare privacy regulations
- Knowledge of both government and commercial insurance reimbursement processes
- Bilingual communication skills to support diverse patient populations
National Average Salary
Reimbursement specialist salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for a Reimbursement Specialist is:
$47,720
Sample Job Description Templates for Reimbursement Specialists
Entry-Level Reimbursement Specialist
Position Overview
We are seeking an entry-level reimbursement specialist to support our billing and claims team. This role is ideal for professionals beginning a career in healthcare finance who want to learn the reimbursement process while ensuring providers receive timely payments.
Responsibilities
- Verify patient insurance eligibility and coverage prior to appointments
- Assist in preparing and submitting insurance claims for processing
- Review claims for accuracy and correct basic billing errors
- Track claim status and escalate unpaid claims as needed
- Answer patient billing inquiries with professionalism and accuracy
- Maintain accurate and confidential patient and financial records
Requirements
Hard skills
- Basic knowledge of medical billing and reimbursement processes
- Familiarity with Microsoft Office or similar software
- Ability to learn EHR and billing systems quickly
- Understanding of HIPAA regulations and confidentiality practices
Soft skills
- Attention to detail and accuracy in data entry
- Good communication and customer service skills
- Eagerness to learn and grow in a healthcare environment
- Ability to stay organized while handling multiple tasks
Education
- High school diploma or GED required; associate’s degree in healthcare administration or business preferred
Certifications
- None required; CRS (Certified Reimbursement Specialist) recommended as career develops
Preferred Qualifications
- Internship or prior experience in medical billing or customer service
- Bilingual communication skills
Mid-Level Reimbursement Specialist
Position Overview
Our organization is hiring a mid-level reimbursement specialist to manage claims processing and payer communications with minimal supervision. This position requires experience in billing and insurance reimbursement and the ability to resolve claim denials efficiently.
Responsibilities
- Prepare, submit, and track claims across Medicare, Medicaid, and commercial insurers
- Review denied or unpaid claims and implement corrections for resubmission
- Communicate with insurance providers to resolve discrepancies
- Assist patients with billing questions and explain payment options
- Maintain claim tracking logs and generate reports for management
- Ensure compliance with state, federal, and payer-specific guidelines
Requirements
Hard skills
- Proficiency in CPT, HCPCS, and ICD-10 coding systems
- Experience with billing and claims management software
- Knowledge of payer reimbursement guidelines and revenue cycle practices
- Ability to analyze denial codes and determine corrective action
Soft skills
- Strong organizational and time management abilities
- Effective written and verbal communication
- Problem-solving and critical thinking skills
- Ability to work independently and manage multiple priorities
Education
- Associate’s degree in healthcare administration, business, or related field required; bachelor’s preferred
Certifications
- CRS certification recommended
- CPC or CCS certification valued
Preferred Qualifications
- 2–4 years of experience in medical billing, claims, or reimbursement
- Familiarity with payer portals and clearinghouses
Senior Reimbursement Specialist
Position Overview
We are looking for a senior reimbursement specialist to handle complex claims, lead reimbursement projects, and mentor junior staff. This role requires advanced knowledge of payer requirements and a proven ability to improve revenue cycle performance.
Responsibilities
- Manage escalated claims and coordinate resolution with payers
- Lead denial management initiatives and track root causes
- Train and mentor entry-level and mid-level reimbursement specialists
- Serve as a subject matter expert on payer-specific regulations
- Collaborate with coding staff to ensure billing accuracy
- Prepare reports and recommend process improvements to leadership
Requirements
Hard skills
- Advanced knowledge of Medicare, Medicaid, and commercial insurance reimbursement
- Expertise in billing and coding systems including CPT, ICD-10, and HCPCS
- Ability to manage denial tracking systems and reporting tools
- Proficiency in EHR and revenue cycle management software
Soft skills
- Leadership and mentoring abilities
- Strong analytical and problem-solving skills
- Excellent communication with staff, patients, and insurers
- Ability to manage competing priorities in fast-paced settings
Education
- Bachelor’s degree in healthcare administration, finance, or related field
Certifications
- CRS certification required
- CPC, CCS, or advanced reimbursement certifications preferred
Preferred Qualifications
- 5+ years of experience in reimbursement or revenue cycle roles
- Proven track record in reducing denials and improving collections
Lead Reimbursement Specialist
Position Overview
We are hiring a lead reimbursement specialist to oversee reimbursement operations, supervise staff, and ensure consistent compliance with payer requirements. This position combines team leadership with technical reimbursement expertise.
Responsibilities
- Supervise reimbursement staff and assign daily tasks
- Oversee claim submission, denial management, and payment posting processes
- Develop department procedures to ensure accuracy and compliance
- Collaborate with management on revenue cycle strategies
- Review team performance metrics and provide coaching
- Manage escalated patient billing or payer issues
Requirements
Hard skills
- Comprehensive knowledge of reimbursement processes and payer regulations
- Experience supervising billing or reimbursement staff
- Ability to manage reporting and compliance tracking tools
- Proficiency in EHR and practice management systems
Soft skills
- Leadership and team management abilities
- Strong problem-solving and conflict resolution skills
- Excellent communication across departments and with external partners
- Ability to multitask and manage high-volume operations
Education
- Bachelor’s degree in healthcare administration, business, or related field
Certifications
- CRS certification required
- CPC or CCS certification recommended
Preferred Qualifications
- Previous supervisory or lead experience in reimbursement or billing
- Experience implementing new billing technologies or processes
Reimbursement Manager
Position Overview
We are seeking a reimbursement manager to lead the reimbursement department, oversee staff performance, and manage financial outcomes related to claims and collections. This leadership role requires advanced revenue cycle knowledge and team management skills.
Responsibilities
- Manage reimbursement staff and daily department operations
- Develop and enforce reimbursement policies and procedures
- Oversee denial management processes and track resolution rates
- Partner with senior leadership on revenue cycle strategy
- Manage department budgets and vendor relationships
- Ensure compliance with HIPAA, CMS, and other regulatory requirements
Requirements
Hard skills
- In-depth knowledge of reimbursement regulations, payer guidelines, and compliance standards
- Experience managing department budgets and resources
- Proficiency with revenue cycle and billing software systems
- Strong data analysis and reporting skills
Soft skills
- Leadership and staff development skills
- Strategic decision-making and organizational abilities
- Strong communication with executives, staff, and external partners
- Ability to manage complex projects and competing priorities
Education
- Bachelor’s degree required; master’s degree in healthcare administration, business, or finance preferred
Certifications
- CRS certification required
- PMP or advanced revenue cycle certification valued
Preferred Qualifications
- 7+ years of reimbursement or revenue cycle experience, with 2+ years in management
- Proven success in reducing denials and improving reimbursement rates
Director of Revenue Cycle
Position Overview
We are seeking a director of revenue cycle to provide executive leadership for all billing, claims, and reimbursement operations. This role ensures that the organization’s financial processes support timely collections, regulatory compliance, and long-term financial health.
Responsibilities
- Lead revenue cycle operations including billing, coding, collections, and reimbursement
- Develop strategic plans to maximize reimbursement and minimize denials
- Manage department budgets, vendor contracts, and financial reporting
- Oversee compliance with federal, state, and payer-specific regulations
- Collaborate with executive leadership on organizational financial goals
- Lead large teams and develop staff at all levels of revenue cycle operations
Requirements
Hard skills
- Expert-level knowledge of revenue cycle management and reimbursement processes
- Strong financial and operational management skills
- Proficiency in EHR, billing, and analytics systems
- Ability to design and implement large-scale compliance programs
Soft skills
- Executive-level leadership and communication abilities
- Strategic planning and organizational development skills
- Strong negotiation and stakeholder management skills
- Ability to inspire and lead large, multidisciplinary teams
Education
- Bachelor’s degree required; master’s degree or MBA strongly preferred
Certifications
- CRS certification required
- HFMA’s Certified Revenue Cycle Executive (CRCE) strongly recommended
Preferred Qualifications
- 10+ years of revenue cycle experience with progressive leadership roles
- Proven success in managing enterprise-level reimbursement operations