[Hiring] Reimbursement Specialist II REMOTE USA

Position: Reimbursement Specialist II – REMOTE

Date Posted: September 19, 2025

Industry: Healthcare / Medical Billing & Revenue Cycle

Employment Type: Full Time

Experience: 5+ years healthcare experience (or 3+ years with an Associate’s Degree)

Qualification: High School Diploma with 5+ years’ healthcare experience OR Associate’s Degree in a healthcare-related field with 3+ years’ experience

Salary: $32.00 – $35.00 per hour

Location: United States — REMOTE  

Company: PRO-spectus

Description:

ABOUT THE ROLE
We are hiring a Reimbursement Specialist II to join our remote-first team. This role focuses on managing appeals and complex payer interactions to secure appropriate reimbursement for healthcare services. The position requires strong familiarity with commercial payers, Medicare, Medicaid and workers’ compensation processes, and the ability to interpret payer policies to resolve claims efficiently.

CORE DUTIES / RESPONSIBILITIES

• AR Collections & Resolution — Drive timely collection of outstanding accounts receivable and resolve billing or claims issues that impede payment.
• Appeals & Policy Research — Investigate, analyze and interpret payer-specific billing policies and appeals requirements to support successful appeals.
• Account Management — Manage assigned accounts proactively to maintain positive cash flow and follow-up on denials or underpayments.
• Payment Validation — Identify payments that don’t match contracted rates or fee schedules and escalate discrepancies to payers for correction.
• Cross-Training & Coverage — Provide backup coverage across the department as needed.
• Clerical & Reporting Tasks — Perform light accounting tasks, data entry, record-keeping and support department projects and administrative needs.

SKILLS / REQUIREMENTS

• Demonstrated experience handling complex appeals and payer-specific billing policies.
• Solid understanding of healthcare billing, coding, and third-party payor processes.
• Strong written and verbal communication skills for effective interactions with payers, providers, patients and internal stakeholders.
• Excellent organization, attention to detail, and the ability to manage shifting priorities.
• Able to remain calm and professional in emotionally charged or stressful situations.
• Quick learner who adopts tools, processes and technology to improve work outcomes.
• High level of accountability for compliance with policies and procedures and sound judgment when escalating issues.
• Comfortable making routine decisions with guidance and tackling novel challenges with persistence.

EDUCATION, CERTIFICATION & EXPERIENCE

• Preferred familiarity with payer clinical guidelines or medical policy.
• Conversant with medical and billing terminology.
• Skilled with computer systems and databases used to manage electronic claim and appeal workflows.
• Interpersonal skills to engage with clinicians, hospital leaders, nursing staff, patients and families.
• Minimum: High School Diploma + 5 years healthcare experience OR Associate’s Degree in a healthcare-related field + 3 years experience.

PHYSICAL REQUIREMENTS

• Remote-first role — work from a professional home environment listed in employment file.
• Prolonged sitting and computer-based work; regular keyboarding and verbal communication.
• Occasionally lift items up to 15 pounds.
• Flexible hours required to support activities across multiple U.S. time zones.

OUR CULTURE & EEO STATEMENT
PRO-spectus cultivates a supportive, team-centered culture that values humility, compassion and a shared commitment to improving patient outcomes. We celebrate personal and professional milestones and encourage collaboration. PRO-spectus is an Equal Opportunity / Affirmative Action employer — all qualified candidates will be considered regardless of protected characteristics.

COMPENSATION & BENEFITS

• Pay Range: $32.00 – $35.00 per hour (final offer depends on experience and qualifications).
• Competitive benefits package designed to support well-being and work-life balance.

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