Lead Reimbursement Specialist

About This Role

This role involves supporting sales teams, providers, and customers by providing accurate coding, coverage, and payment guidance for IVS technologies. You will research payer policies, update coding documents, manage inquiries, and train junior team members.

Responsibilities

• Support reimbursement inquiries from sales teams, providers, and customers by delivering accurate coding, coverage, and payment guidance within established service levels
• Conduct in‑depth research on coding, payer policies, and regulatory updates to resolve complex reimbursement questions and inform internal decision-making
• Review and update coding documents to maintain accuracy of CPT, HCPCS, ICD‑9, and ICD‑10 assignments
• Manage all Coding Hotline and email inquiries, tracking and trending contact data to identify patterns and opportunities for improvement
• Collaborate with providers to research, troubleshoot, and resolve claim issues, including prior authorization, denials, and appeals
• Coordinate with Sales Representatives to deliver required documentation and ensure customer billing and reimbursement needs are met
• Develop and deploy payer and provider communications that highlight the value of IVS products and support reimbursement education
• Provide training, mentorship, and support to new and junior reimbursement team members to help accelerate their proficiency and performance

Requirements

• Extensive experience providing coding, coverage, and payment guidance in a healthcare environment
• Extensive experience supporting prior authorization, denials, and appeals processes
• Comprehensive knowledge of medical coding guidelines and ability to review operative reports, rejected claims, and EOBs
• Comprehensive knowledge of Medicare, Medicare Advantage, Medigap, and commercial payer methodologies

Qualifications

• Bachelor’s degree and minimum 4 years of relevant experience, or Associate’s degree and minimum 8 years of relevant experience, or High school diploma/equivalent and minimum 10 years of relevant experience.
• Minimum 4 years of relevant experience with a Bachelor's degree, 8 years with an Associate's, or 10 years with a high school diploma/equivalent, including extensive experience in healthcare coding, coverage, and payment guidance and supporting prior authorizations, denials, and appeals.

Nice to Have

• CPC (Certified Professional Coder)
• CCS‑P (Certified Coding Specialist – Physician)

Benefits