Remote Medical Reimbursement Claims Specialist – Patient Advocacy, Revenue Integrity & Compliance at brighthush

About brighthush and the Healthcare Landscape

brighthush is a forward‑thinking, patient‑centric healthcare organization that is redefining how care is delivered across the United States. With a portfolio that spans hospitals, urgent‑care centers, imaging facilities, and specialty practices, brighthush is committed to delivering high‑quality, affordable care while fostering a culture of innovation, collaboration, and continuous improvement. Our mission is simple: to improve health outcomes for the communities we serve by ensuring that every patient receives the right care at the right time, and that our partners are reimbursed accurately and efficiently.

In today’s rapidly evolving healthcare environment, the role of a Reimbursement Claims Specialist is more critical than ever. Accurate claims processing, timely resolution of discrepancies, and adherence to payer guidelines directly impact patient satisfaction, provider revenue, and the overall financial health of the organization. As a Remote Medical Reimbursement Claims Specialist, you will be at the forefront of this mission, ensuring that our patients receive the care they need while our revenue cycle remains robust and compliant.

Key Responsibilities

• Claims Processing & Verification – Review, process, and verify reimbursement claims to ensure accuracy, compliance with payer guidelines, and adherence to regulatory requirements.
• Discrepancy Resolution – Identify, investigate, and resolve claim discrepancies, denials, and underpayments, taking appropriate corrective action to secure timely reimbursement.
• Transaction Coding – Apply correct transaction codes and modifiers to accounts, ensuring proper claim adjudication and seamless reimbursement flow.
• Outstanding Claims Management – Monitor and follow up on outstanding claims, maintaining a proactive approach to collection and payment reconciliation.
• Collaboration & Communication – Work closely with revenue cycle teams, payers, and internal stakeholders to investigate denials, appeal decisions, and resolve complex reimbursement issues.
• Payer Policy Research – Stay current on payer policies, claim submission rules, and reimbursement standards, translating this knowledge into actionable insights for the team.
• Documentation & Compliance – Accurately document all account actions in the appropriate systems, ensuring compliance with department protocols and HIPAA regulations.
• Process Improvement – Identify opportunities to streamline reimbursement workflows, reduce errors, and enhance overall efficiency.
• Confidentiality & Security – Maintain strict confidentiality of patient and financial information, safeguarding data in accordance with HIPAA and corporate policies.
• Additional Duties – Perform other related tasks as assigned, contributing to the continuous improvement of the revenue cycle.

Essential Qualifications

• High School Diploma or GED (required).
• 0–1 year(s) of experience in medical billing, reimbursement, claims processing, or accounts receivable.
• Strong foundational knowledge of medical billing terminology, payer guidelines, and reimbursement procedures.
• Proficiency with electronic health record (EHR) systems, billing software, and reimbursement platforms.
• Basic understanding of HIPAA, compliance regulations, and healthcare reimbursement standards.
• Excellent analytical skills with the ability to review account balances, identify discrepancies, and apply appropriate adjustments.
• Effective communication skills, both written and verbal, enabling clear collaboration with payers, internal teams, and patients.
• Self‑motivated, detail‑oriented, and capable of working independently in a remote environment.

Preferred Qualifications

• Associate Degree or coursework in Accounting, Finance, Healthcare Administration, or a related field.
• Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations.
• Familiarity with denial management, appeals processes, and payer communication protocols.
• Knowledge of advanced billing software, analytics tools, and reporting dashboards.
• Demonstrated ability to implement process improvements that reduce cycle time and increase accuracy.
• Experience working in a large, multi‑site healthcare organization or a shared services environment.

Skills & Competencies

• Technical Proficiency – Advanced skills in EHR systems, billing software, and reimbursement platforms.
• Analytical Thinking – Strong problem‑solving and critical‑thinking abilities to resolve complex claims issues.
• Attention to Detail – Meticulous approach to data entry, documentation, and compliance checks.
• Communication & Collaboration – Ability to build relationships with payers, internal stakeholders, and patients.
• Adaptability – Comfortable navigating changing payer policies, regulatory updates, and evolving technology.
• Time Management – Efficiently prioritize tasks to meet daily, weekly, and monthly performance metrics.
• Compliance Mindset – Deep understanding of HIPAA, privacy regulations, and ethical handling of sensitive information.

Career Growth & Learning Opportunities

At brighthush, we believe that professional growth is a shared journey. As a Remote Medical Reimbursement Claims Specialist, you will have access to:

• Structured onboarding and mentorship programs that accelerate your learning curve.
• Regular training sessions on the latest payer policies, billing technologies, and compliance updates.
• Opportunities to cross‑train in related revenue cycle functions such as coding, denial management, or patient financial counseling.
• Clear career pathways to roles such as Senior Claims Analyst, Revenue Cycle Manager, or Compliance Officer.
• Support for continuing education, certifications (e.g., Certified Professional Biller, Certified Revenue Cycle Professional), and tuition reimbursement.
• Access to a robust internal knowledge base, webinars, and industry conferences.

Work Environment & Company Culture

brighthush is proud of its inclusive, collaborative culture that values every team member’s contributions. Even though this position is fully remote, you will experience:

• Regular virtual team huddles and cross‑departmental meetings to foster connection and alignment.
• Transparent communication channels, including instant messaging, video conferencing, and an internal collaboration platform.
• A culture of continuous improvement where your ideas for process enhancements are welcomed and acted upon.
• Recognition programs that celebrate achievements, milestones, and exceptional performance.
• Flexibility to balance professional responsibilities with personal commitments, supported by a robust remote work policy.

Compensation, Perks, and Benefits

While specific salary ranges are determined by experience and market conditions, brighthush offers a competitive compensation package that includes:

• Competitive base salary aligned with industry standards.
• Performance‑based bonuses tied to key metrics such as claim accuracy, denial reduction, and cycle time.
• Comprehensive health benefits – medical, dental, and vision coverage for you and your dependents.
• 401(k) plan with company match to help you build long‑term financial security.
• Generous paid time off (PTO) and holiday schedule to support work‑life balance.
• Tuition reimbursement program to support your professional development.
• Wellness initiatives, including virtual fitness classes, mental health resources, and employee assistance programs.
• Flexible work schedule and fully remote setup, eliminating commute time and allowing you to work from anywhere in the United States.

How to Apply

If you are passionate about ensuring patients receive the care they deserve and are eager to contribute to a dynamic, patient‑focused organization, we encourage you to apply today. Submit your resume and a brief cover letter outlining your relevant experience and why you are excited about this role at brighthush.

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Join brighthush – Where Your Expertise Meets Purpose

At brighthush, we don’t just offer a job; we offer a platform where your skills are recognized, your growth is nurtured, and your impact is tangible. As a Remote Medical Reimbursement Claims Specialist, you will play a pivotal role in safeguarding the financial health of our organization while ensuring that patients receive the care they need. If you thrive in a collaborative, data‑driven environment and are ready to take the next step in your career, we want to hear from you.

Apply now and become part of a team that is dedicated to excellence, innovation, and compassionate care.