Medicare Reimbursement Specialist
Diplomat Specialty Pharmacy - Flint, MI

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The Medicare Reimbursement Specialist has knowledge of commonly-used concepts, practices, and procedures within the Medical Billing and Accounts Receivable field. This position relies on instructions and pre-established guidelines to perform the functions of the job and works under immediate supervision of the Accounts Receivable Supervisor.


This position reports to the Accounts Receivable Supervisor.

There are no direct reports to this position.

Education : High School Diploma or G.E.D required.

Experience : One to two years prior experience in Medicare billing is preferred.

Skills/Knowledge :
Knowledge of insurance coding and billing procedures.

Familiar with hard copy billing plans.

Possess excellent communication skills, a positive work attitude and willingness to learn and grow in the position.

Should be organized and able to prioritize and manage time effectively.

Must be detail-oriented and be able to multi-task.

Be able to work well with various personalities and work as a team.

Should be independent and self-motivated – able to work and accomplish goals with little to no supervision.

Must be dependable and able to act with discretion maintaining levels of strict confidentiality.

General knowledge of Internet navigation and research, e-mail, fax transmission, and copy equipment are essential.

Physical : Sitting for prolonged periods of time at a desk. Walking, standing, bending, crouching and capable of lifting up to 35 pounds.

Mental : Basic math skills and computer aptitude.

Language : Fluency in English with outgoing personality that translates to phone skills with excellent verbal and written communication skills.

Reasoning : Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

Technology : Proficient in Windows based operating systems and Microsoft Office programs including Word, Excel, and Outlook. Familiar with Rx30.


Variable in a climate controlled office environment.


Verifies proof of delivery for Medicare claims

Appeal rejections and incorrect payments

Submit HCFA 1500 claim forms to insurance companies

Follow up on any open claims once a month

Report errors on the error log report or to operations

Document notes in eNav and Rx30

Log calls in eNav when speaking with insurance companies

Take/Initiate Patient and insurance phone inquiries

Report any findings to management

Refunds for Medicare and crossover incorrect payments

Other Duties and Responsibilities as assigned.

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