Reimbursement Supervisor
hace 17 días
McKinney
Job DescriptionBenefits: • Competitive salary, • Flexible schedule, • Paid time off, • Training & development Job Title: Reimbursement Manager Department: Revenue Cycle / Billing Reports To: CEO Job Type: Full-Time Location: McKinney, TX Position Summary: The Reimbursement Manager is responsible for leading and supervising all aspects of the reimbursement and medical billing process. This role oversees a team of specialists to ensure accurate claim submissions, payment collections, compliance with payer and regulatory requirements, and timely resolution of billing issues. The Reimbursement Manager also plays a key role in training, workflow optimization, and payer communication to ensure the financial health of the organization. Key Responsibilities: • Supervise daily operations of the reimbursement team including claim submission, billing edits, denials, and collections., • Ensure timely and accurate submission of claims (electronic and paper) with appropriate documentation (e.g., DIFs, DWOs, LOAs)., • Monitor and improve reimbursement processes and metrics such as days in A/R, denial rates, and collection effectiveness., • Review and ensure proper use of billing codes (HCPCS, CPT, ICD-10), NDC units, J-codes, and Place of Service., • Resolve escalated issues related to front-end denials, payer rejections, and complex reimbursement discrepancies., • Oversee setup and maintenance of payers in the billing system., • Maintain up-to-date knowledge of Medicare, Medicaid, commercial payer guidelines, and specialty pharmacy/home infusion billing requirements., • Coordinate billing and follow-up for third-party payers, co-pay assistance programs, foundations, and manufacturer support programs., • Oversee documentation for refunds to payers or patients and coordinate payment information with cash posting staff., • Audit delivery tickets and ensure eligibility for financial assistance programs., • Review and approve patient hardship waivers; maintain tracking and documentation., • Compile and analyze reimbursement reports for leadership and make recommendations for improvement., • Train and support staff on billing procedures, system updates, and payer changes., • Ensure compliance with all federal, state, and local billing regulations.Qualifications: Required: • Bachelors degree in Healthcare Administration, Finance, or related field; or equivalent experience/certification (Medical Billing Certificate acceptable)., • 5+ years of medical billing or reimbursement experience, preferably in home infusion or specialty pharmacy., • Strong understanding of coding (CPT, HCPCS, ICD-10), insurance claim submission, and billing workflows., • Knowledge of federal/state billing guidelines, including Medicare and commercial payer requirements., • Experience with electronic claim transmissions, clearinghouses, and denial management., • Proficiency in Microsoft Excel, Word, Outlook., • Strong math skills, including unit conversions (e.g., grams to milligrams)., • Excellent communication, problem-solving, and organizational skills.Preferred:, • Knowledge of home infusion, specialty infusion, and pharmacy billing practices., • Experience with reimbursement support programs and co-pay assistance., • Familiarity with HCFA 1500 claim requirements., • Prior supervisory or leadership experience in a billing/reimbursement setting.Working Conditions:, • Must be able to work flexible hours as needed based on business demands.