Reimbursement Manager

Responsibilities

• Lead and oversee the Accounts Receivable staff to ensure consistent follow-up and resolution of unpaid, incorrectly, or partially paid and denied medical and dental claims for services provided in Post Acute care setting.
• Ensure timely identification and resolution of payer denial trends; work closely with payer provider relations, claims processing management, and other departments as required by the payers to resolve denial and incorrect payment issues.
• Provide hands-on training and daily support to staff on systems and processes to address and resolve AR-related issues daily.
• Review and improve processes to increase staff and system efficiency to ensure achievement of Revenue Cycle Key Performance Indicators (Minimize upfront claim rejections and denials, bad debt write-offs, reduce DSO and increase daily cash collections).
• Educate staff on compliant actions for resolving Medicare, State Medicaid, and third-payer payer claim issues.
• Review outstanding AR balances regularly, make recommendations for bad debt, and ensure timely adjustment processing.
• Implement enhanced productivity and quality measurement tools for the Accounts Receivable area.
• Foster a positive, team-oriented, and inclusive work environment, building confidence and trust among team members.
• Effectively communicate goals and objectives to team members, monitoring progress daily.
• Provide extensive hands-on training to new staff and ongoing development for existing employees on systems, payer requirements, and policies.
• Manage RCM external vendor relationships.
• Develop and implement standardized policies and procedures and programs for onboarding and retraining; including detailed training manual for denial resolution management, appeals and other AR related tasks.
• Evaluate employee performance, provide ongoing feedback, draft annual performance reviews, and conduct review meetings, implementing performance improvement plans as needed.
• Assist with various projects and month-end close processes to meet business objectives.

Qualifications

• Strong organizational, leadership, and interpersonal skills.
• Excellent analytical, problem-solving, and prioritization skills.
• Strong time management skills with the ability to adapt to change and multitask effectively.
• Excellent written and verbal communication skills, with a hands-on leadership approach and strong work ethic.
• Ability to hire, develop, and mentor staff for optimal performance.
• Ability to analyze processes, systems, and implement changes to improve staff efficiency and results.
• Willingness to work additional hours on a daily basis to ensure business objectives are achieved.
• Proficiency in Microsoft Office applications (Excel, Outlook, and Word).
• Relevant Associate’s Degree or equivalent combination of education and work experience.
• 7+ years of experience in healthcare billing and collections, with at least 5 years of supervisory or management experience.
• Extensive knowledge of Medicare, Medicaid, and third-party insurance plan requirements and regulations for physician billing, denial resolution management, and insurance eligibility.
• Preference for candidates with experience from large volume multi-specialty physician practice providing services to patients in Post Acute Care setting.
• Experience managing RCM vendor relationships.