Reimbursement Specialist

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 Powered by JazzHR