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Reimbursement Specialist

Compass Consulting Group, Danville CA


  • Investigates patient' s insurance benefits. Identifies network providers, provider restrictions, co-pays as needed.
  • Documents requirements for prior authorization and medical review process.
  • Documents activities appropriately in progress notes.
  • Pursue product coverage for patients in accordance with the payor' s authorization requirements within the department' s established performance criteria.
  • Create written communication to customers regarding reimbursement status.
  • Maintains payor profiles by recording payor specific data promptly into the system. Consults with team members on an as needed basis.
  • Collects and enters data for distributor referral cases.


  • 4 years experience in Healthcare reimbursement required; verifying benefits, prior authorizations and working with public and private insurance.
  • Must be able to drive for results.
  • Proficient in all aspects of reimbursement (i.e. benefit investigation, pay reimbursement policies).
  • Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
  • Ability to work collaboratively in a team structure and responsibly delegates next steps to appropriate team members.
  • Demonstrates effective problem solving and excellent customer service.
  • Exceptional attention to detail and ability to prioritize tasks.
  • Requires computers skills including MS Excel.


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