Reimbursement Supervisor

About Us

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.

Position Summary. The Reimbursement Supervisor is responsible for managing, leading and supporting a team of reimbursement case managers who support product access for both medical and pharmacy benefits, commercial and government payers as well as alternate funding agencies. In addition, this position will understand and lead the team to meet and exceed key performance indicators and contracted SLAs and help resolve and remedy escalated issues.

• Assist the Program Manager and Account Director to manage day-to-day activities of the programs and specific tasks including management of program telephone queue.
• Complete quality monitoring and quality assurance activities for team Reimbursement Analysts.
• Coach/mentor staff in case management, intake coordination, and other roles in support of client requirements.
• Prepare client facing and internal reports, as required.
• Understand metrics and identify solutions to improve team performance.
• Assist in training team members, including program specific Standard Operating Procedures (SOPs).
• Draft SOPs, work instructions, business rules to provide guidance to team members.
• Test and assist in determination of CRM, telephony, and other system tools.
• Manage mailings, fax, and email blasts.
• Perform case management activities as needed to support peak times.
• Assist callers/clients with coverage needs, billing and coding, insurance benefit investigations, prior authorization, and appeals inquiries.
• May act as regional contact for senior level client representatives.
• Review and resolve denied or underpaid insurance claims.
• Monitor and update payer prior authorization requirements and coverage policies for specified client program.
• Participate in conference calls with senior level client contacts as required by program guidelines.
• Travel to and attend client meetings, off-site training, and/or conferences. Travel time estimate: 10%.

• Minimum four years of recent healthcare experience (2 years’ direct industry preferred).
• Advanced knowledge of medical insurance (public and commercial), billing and coding and associated terminology.
• Prior supervisory experience a plus.
• Excellent customer service skills (call center experience preferred).
• Advanced problem solving, research and analytical skills.
• Advanced communication skills, both written and verbal.
• Data entry accuracy required.
• Ability to multi-task and manage time independently.
• Managing, leading, and developing teams.
• Interview and hiring experience preferred.
• Exhibit proficiency in Microsoft Office products.
• Client interaction experience.

• Location:
  
  Remote
• Schedule:
  
  Full-time
• May require availability or flexibility for escalations.
• Regular meetings with teams, departments, or leadership to ensure alignment.

• Ability to sit for extended periods of time while working at a computer and on the phone throughout the workday.
• Ability to engage in continuous phone and computer use, including navigating multiple systems simultaneously, for the duration of the shift.
• Ability to perform repetitive motions for an entire shift, including typing, mouse use, and phone handling.
• Ability to view and read information on a computer screen for prolonged periods.
• Ability to communicate clearly and professionally via phone, email, and internal systems.
• Ability to manage a high volume of inbound and outbound calls while maintaining attention to detail and accuracy.
• Ability to work in a remote environment with minimal distractions and maintain productivity and performance standards.
• Ability to adapt to changing priorities, workflows, and processes in a fast-paced environment.
• Ability to meet attendance, schedule adherence, and performance expectations, including flexibility for occasional extended hours or weekends as business needs require.

Employment Classification
Status:
Full-time
FLSA:
Exempt

Equal Employment Opportunity (EEO) Statement

Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status. We celebrate diversity and are committed to creating an inclusive environment for all employees. If you do not meet every requirement but still feel you would be a great fit for this role, we encourage you to apply!

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all…