Reimbursement Specialist

Job Description

Job Description

About Aptiva Medical

Aptiva Medical is a rapidly growing national leader in direct-to-consumer Continuous Glucose Monitor (CGM) supplies. We're on a mission to make diabetes management seamless for patients across America by providing convenient recurring deliveries and handling all the complexity of insurance billing—so patients can focus on their health, not paperwork.

The Opportunity

Our Revenue Cycle Management team is the engine that drives our growth. We're looking for exceptional problem-solvers who thrive on challenges, take ownership of outcomes, and aren't satisfied until every dollar of legitimate reimbursement is recovered.

What You’ll Do

Denials Management & Recovery (Primary Focus)

Work and resolve claim denials with urgency to maximize recovery rates

Identify denial patterns, complete root-cause analyses, and implement corrective actions

Prepare persuasive, well-documented appeals; track and report denial metrics

Collaborate with clinical / operations teams to eliminate systemic triggers

Claims Submission & QA

Perform front-end edits to ensure clean first-pass submissions

Submit / adjust electronic claims (Medicare, Medicaid, commercial) in real time

Maintain expert knowledge of payer-specific requirements

Payment Posting & Reconciliation

Post payments / adjustments with precision; reconcile remittances

Tie adjustments to correct GL accounts; investigate variances / underpayments

Insurance Verification & Documentation

Complete comprehensive verifications via portals and payer calls

Gather / validate documentation and respond to audit requests promptly

Accounts Receivable (AR)

Work AR aging to goals; resolve rejections to maintain cash flow

Make strategic outbound payer calls; process refunds / payment plans as needed

Compliance & Continuous Improvement

Adhere to Medicare / Medicaid and commercial payer regulations

Stay current on policy / coding updates; contribute to team training and process improvements

What You’ll Bring

Experience

2–4 years in medical billing, insurance reimbursement, or RCM

Demonstrated success resolving complex denials and lifting recovery rates

DME billing strongly preferred; Medicare Part B and / or Medicaid required

Technical Skills

Proficiency with electronic claim submission platforms

Strong ERA / EOB interpretation; high-accuracy data entry

Comfortable working across multiple systems; advanced Excel skills

Knowledge

Medicare / Medicaid compliance; CPT / HCPCS coding & modifiers

Payer contracts, allowables, reimbursement methodologies

AR principles (debits / credits, GL coding)

Core Competencies

Analytical, curious, and tenacious problem-solver

Clear written / verbal communicator (technical and non-technical)

Organized, self-directed, and accountable; calm under volume / pressure

Collaborative across clinical, operations, and customer service teams

Nice to Have

Bachelor’s in healthcare administration, business, or related field

CRCR or similar certification

Experience with CGM / diabetes supplies; exposure to Lean / Six Sigma

Why Aptiva

Impact :  Your wins keep patients supplied without interruption

Autonomy :  Own decisions and drive outcomes without red tape

Growth :  Rapid expansion = real advancement opportunities

Team :  Knowledge-sharing culture that celebrates wins

Schedule :  Monday–Friday; no on-call

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