Reimbursement Specialist
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Job Description
Reimbursement Specialist processing medical claims and payer documentation for LUX Infusion’s patient-focused infusion care. Supporting accurate reimbursement and uninterrupted access to therapy.
Responsibilities:
- Submit accurate, timely clean claims to primary and secondary payers
- Review, correct, and promptly resubmit rejected or denied claims
- Verify insurance eligibility, authorizations, and documentation before medication delivery
- Maintain complete patient billing files, including CMNs, prescriptions, and medical documentation
- Confirm delivery dates before claim submission and invoice patients for applicable responsibility amounts
- Partner with pharmacy, care coordination, and field staff to resolve billing issues
- Track accounts receivable activity and maintain detailed AR status reporting
- Communicate with insurance companies, providers, and internal teams about claim status
- Predict cash flow based on claim progression and payer response patterns
- Document payer communications and follow-ups
- Respond to payer requests for records, authorizations, and clinical documentation
- Support insurance contract maintenance and payer audits
- Monitor payer behavior, coverage changes, and industry updates, escalating concerns appropriately
- Participate in quality assurance activities, audits, training, and continuing education initiatives
Requirements:
- At least two years of medical insurance or reimbursement experience
- Strong attention to detail and ability to manage multiple priorities
- Clear verbal and written communication skills
- Comfort working with billing systems, payer portals, and Microsoft Office tools
- Strong customer service mindset and professionalism when resolving complex payer issues
- Ability to stay organized and adaptable amid changing workloads
- Ability to work 8:30am–5:00pm CST or EST
- Participate annually in required legal and ethical compliance training
- Comply with LUX Infusion’s legal, ethical, and compliance policies and Compliance Manual
- Home infusion or specialty pharmacy reimbursement experience preferred but not required
- Familiarity with CPR+ and/or CareTend systems preferred but not required
- Certified Pharmacy Technician credentials preferred but not required
- Experience supporting patients with chronic or rare conditions preferred but not required
- Ability to occasionally stand, walk, sit, use hands, reach, climb stairs, balance, stoop, kneel, crouch, crawl, talk, and hear
- Ability to occasionally lift and/or move up to 25 pounds
Benefits:
- Purpose-driven work that directly supports patient care
- Patient-first, clinician-led culture
- Collaborative teams across pharmacy, revenue cycle, and care coordination
- Opportunities to grow expertise in specialty infusion reimbursement
- Reasonable accommodations for individuals with disabilities
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