Reimbursement Manager

Description

We are currently seeking an experienced Manager of Reimbursement to join our team. The ideal candidate will be knowledgeable in reimbursement methodologies and will have a proven track record of leading teams to success. The Manager will have excellent communication and problem-solving skills, as well as the ability to build relationships with internal and external stakeholders. You will be responsible for developing, leading, and executing strategies to optimize and improve reimbursement related processes.

If you are a seasoned professional with a passion for delivering results, we look forward to receiving your application. To learn more about our company and services, please visit us at Prompt Care In-home Respiratory and Infusion

Reports to: Vice President, Revenue Cycle Management

Job Type
:
Exempt, Full/Time

• Minimum of 5–8 years of healthcare accounts receivable, medical billing, reimbursement, or revenue cycle experience; DME experience strongly preferred.
• Prior leadership experience managing billing, collections, payment posting, denial management, or AR follow-up teams.
• Strong working knowledge of healthcare billing, Medicare, Medicaid, commercial payer requirements, prior authorization, documentation requirements, modifiers, and payer‑specific claim rules.
• Experience analyzing AR aging, denial trends, payer issues, unapplied cash, recoupments, refunds, and outstanding balances.
• Demonstrated ability to identify root causes of delayed reimbursement and implement corrective action plans.
• Experience working with clearinghouses, payer portals, eligibility systems, electronic remittance advice, and billing platforms such as Brightree, Niko Health, or similar systems.
• Strong understanding of HIPAA, payer compliance requirements, timely filing limits, appeal processes, and audit documentation.
• Proficiency with Microsoft Excel and Microsoft Office; ability to create, interpret, and present AR reports and performance dashboards.
• Excellent communication, coaching, problem‑solving, and organizational skills.
• Ability to collaborate effectively with intake, customer service, operations, clinical, finance, and leadership teams.
• Degree in healthcare administration, business, accounting, finance, or equivalent experience.
• Medical billing, coding, revenue cycle, or DME‑related certification a plus

• Manage daily accounts receivable operations for respiratory division billing, collections, payment posting, denial follow‑up, and payer resolution.
• Monitor AR aging reports by payer, account, aging bucket, denial reason, and dollar value to prioritize collection activity.
• Lead and supervise AR staff, including billing specialists, follow‑up representatives, denial specialists, and payment posters.
• Establish productivity standards, quality expectations, workflows, and accountability measures for the AR team.
• Review claim denials, rejections, underpayments, over payments, recoupments, and refund requests to ensure timely resolution.
• Identify recurring reimbursement barriers and partner with internal teams to resolve root causes, including documentation gaps, authorization issues, payer setup problems, coding/modifier errors, and eligibility concerns.
• Ensure claims are billed accurately and in compliance with payer contracts, Medicare/Medicaid requirements, DME documentation standards, and company policies.
• Develop and maintain payer‑specific processes, escalation pathways, and appeal workflows.
• Track key performance indicators, including days sales outstanding, clean claim rate, denial rate, collection rate, aging over 90 days, and staff productivity.
• Prepare regular AR performance reports for leadership and recommend strategies to improve cash flow…