Reimbursement Manager - Healthcare Claims, Denials, Revenue Ops

About the role

This position leads and optimizes reimbursement operations across the organization’s programs and services, overseeing claims processing, denial management, reimbursement performance, regulatory compliance, and revenue optimization. The Manager develops the reimbursement team, monitors key performance indicators, identifies opportunities to reduce revenue leakage, and partners with internal and external stakeholders to ensure timely and accurate reimbursement.

Responsibilities

• Oversee the timely and accurate submission, processing, follow-up, and resolution of claims while ensuring compliance with payer requirements and applicable reimbursement regulations.
• Develop and implement strategies to maximize reimbursement and reduce revenue leakage.
• Analyze reimbursement trends, identify opportunities, and make recommendations for continuous process improvement.
• Ensure compliance with healthcare regulations, such as HIPAA, Medicare, and Medicaid.
• Monitor claim denials while collaborating with internal team members and external stakeholders such as insurance providers and government agencies to resolve.
• Develop and maintain relationships to ensure successful reimbursement outcomes.
• Act as a liaison between the organization and key stakeholders: collaborate with healthcare providers, billing departments, and insurance companies to resolve reimbursement-related issues.
• Keep abreast of codes, fee schedules, and changes in reimbursement guidelines and adjust processes accordingly.
• Provide team leadership, development, training, and support to staff on reimbursement policies and procedures.
• Conduct team performance reviews, training, ongoing coaching, and planning for coverage needs.

Requirements

• Bachelor's degree in healthcare administration, business, or a related field (Master's degree preferred).
• 5+ years of experience in healthcare reimbursement, with a proven track record of successful management.
• Experience in people-management and leading remote teams across various time zones.
• Strong knowledge of healthcare reimbursement regulations and policies.
• Proficiency in healthcare billing and coding.
• Proficiency in Microsoft Excel to analyze and report revenue cycle data.
• Proficiency in Microsoft PowerPoint to create presentations communicating key metrics, trends, and operational performance to leadership.

Skills

• Excellent analytical, problem-solving, and decision-making skills.
• Effective communication and interpersonal skills.
• Detail-oriented with a focus on accuracy and compliance.
• Strong proficiency in relevant software and data analysis tools.

Physical Requirements

• Operates in a virtual professional office environment and teleworks from the employee’s home address.
• Prolonged periods of sitting at a desk and working on a computer.
• Keyboarding and speaking.
• Must be able to lift up to 15 pounds at times.
• Flexibility of working hours to support activities across EST to PST zones.
• Minimal travel possible.

Pay

The annual range for this position is $92,000 - $100,000, based on experience and qualifications.

Benefits

• Robust medical, dental, and vision plans.
• Life insurance and disability coverage.
• Tax-advantaged savings accounts.
• Employee Assistance Program.
• Home office benefits.
• Employee Ownership Program.
• Paid time off, holidays, and bereavement leave.
• 401(k)-retirement plan with employer matching.
• Eligibility for a performance-based bonus opportunity.