Reimbursement & Appeals Supervisor

The Reimbursement & Appeals Supervisor provides direct leadership for back-end revenue cycle operations focused on payer denials, appeals, reimbursement, and revenue recovery. This position oversees daily work distribution, staff performance, appeal quality and timeliness, payer follow-up, and resolution of complex reimbursement barriers. The Supervisor uses data, payer policy, and root-cause analysis to improve appeal outcomes, reduce preventable denials, and support accurate, timely reimbursement across commercial and government payers.

This role is distinct from front-end billing supervision. Success requires demonstrated experience leading denial and appeal workflows, interpreting payer requirements, evaluating reimbursement outcomes, and translating trends into operational improvements.

Location note: The Medical Biller Supervisor opening is a hybrid position that requires on-site work out of our Carlsbad office Monday, Wednesday, and Thursday, and candidates must live within commuting distance.

• Oversee daily denial, appeal, payer follow-up, and reimbursement recovery activities, ensuring work is prioritized by filing deadline, appeal level, balance, aging, payer requirements, and likelihood of recovery.
• Direct the review and resolution of complex denials, including medical necessity, coding, bundling, modifier, timely filing, documentation, and reimbursement-related denials.
• Ensure appeals are accurate, complete, persuasive, supported by applicable records and payer policy, and submitted within contractual or regulatory timeframes.
• Guide escalation through payer-specific reconsideration, external review, administrative, regulatory, and other dispute pathways when appropriate.
• Monitor appeal inventory, aging, overturn rates, recovered revenue, upheld denials, write-offs, and unresolved payer issues.
• Review underpayments and reimbursement variances; coordinate corrective action and payer escalation when payments do not align with applicable terms, policies, or expected reimbursement.
• Maintain effective controls for appeal tracking, follow-up dates, correspondence, evidence, outcomes, and final account disposition.

• Analyze denial and reimbursement data to identify recurring payer, process, documentation, coding, authorization, and system-related trends.
• Perform root-cause analysis and develop measurable corrective action plans that address both recovery of affected claims and prevention of future denials.
• Partner with front-end billing, coding, patient relations, provider support, market access, laboratory operations, finance, compliance, and technology teams to resolve upstream and downstream revenue cycle issues.
• Recommend and implement sustainable workflow, system, worklist, reporting, and documentation improvements; avoid unnecessary manual workarounds when an electronic or automated solution is available.
• Maintain current standard operating procedures, work instructions, appeal templates, payer reference materials, and escalation pathways.

• Provide direct supervision, coaching, and development to assigned staff, including workload management, attendance, productivity, quality, professional conduct, and completion of assigned responsibilities.
• Establish clear individual and team expectations, production standards, quality measures, and follow-up requirements aligned with departmental goals.
• Conduct regular one-on-one meetings, team meetings, performance reviews, and documented coaching conversations.
• Identify performance or behavioral concerns promptly and address them objectively and consistently in partnership with Human Resources and Revenue Cycle leadership.
• Support Billing Leads and subject-matter experts in training, work review, quality audits, corrective action, and knowledge development.
• Create a collaborative, accountable work environment in which employees are encouraged to raise concerns, propose solutions, and communicate barriers early.
• Plan coverage, redistribute work as necessary, and respond to volume fluctuations, absences, payer deadlines, and urgent escalations.

• Prepare and analyze weekly and monthly operational reports for Revenue Cycle leadership, including denial volume, denial rate, aging, appeal inventory, overturn rate, recovered revenue, productivity, quality, and payer-specific risk.
• Use reporting to distinguish isolated errors from systemic issues and to identify responsible workflows, affected populations, financial exposure, and required corrective action.
• Monitor accounts receivable and payer worklists to ensure timely, accurate follow-up and appropriate account resolution.
• Communicate material trends, operational risks, payer issues, and recommended actions clearly to leadership and cross-functional stakeholders.
• Participate in projects, audits, test launches, system implementations, and payer initiatives that affect reimbursement or denial risk.

• Communicate effectively across in-person and virtual environments using Outlook, Microsoft Teams, Zoom, shared documents, spreadsheets, reporting tools, billing systems, and payer portals.
• Select the appropriate communication channel based on urgency, complexity, audience, documentation needs, and required follow-up.
• Facilitate meetings with clear objectives, decisions, owners, and due dates; ensure action items are documented and completed.
• Handle escalated payer, provider, patient, and internal stakeholder concerns professionally, accurately, and within appropriate authority.
• Build productive partnerships while maintaining accountability for deadlines, deliverables, and operational standards.

• Ensure denial, appeal, reimbursement, and account resolution activities comply with applicable federal and state requirements, payer guidelines, contractual obligations, organizational policies, and privacy standards.
• Remain current on payer policies, reimbursement requirements, appeal rights, coding and billing guidance, and relevant industry developments.
• Ensure staff follow approved procedures and maintain complete, accurate, and audit-ready account documentation.
• Identify compliance or quality concerns, escalate them appropriately, and implement corrective actions in partnership with leadership and Compliance.
• Protect confidential patient, provider, employee, payer, and company information.

• Two (2) or more years of direct supervisory or formal team leadership experience in a healthcare business office, revenue cycle, laboratory, hospital, physician, or similar payer-facing environment.
• Five (5) or more years of progressive healthcare revenue cycle experience with substantial hands-on responsibility for back-end denials, appeals, payer follow-up, reimbursement, or revenue recovery.
• Demonstrated experience managing multiple denial categories and appeal levels across commercial and government payers.
• Working knowledge of payer policies, claim adjudication, medical necessity, authorization and referral requirements, coding-related denials, timely filing, reimbursement methodologies, and appeal documentation.
• Experience using denial and reimbursement metrics to identify trends, quantify financial impact, develop corrective actions, and monitor results.
• Demonstrated ability to coach employees, manage performance, establish accountability, and develop staff.
• Strong analytical, critical-thinking, investigation, and problem-solving skills, with consistent attention to detail and follow-through.
• Clear and professional written, verbal, listening, and presentation skills, including experience communicating with leaders and cross-functional stakeholders.
• Advanced working knowledge of Microsoft Excel and comfort using Outlook, Microsoft Teams, Zoom, shared-document platforms, billing systems, reporting tools, and multiple payer portals.
• Ability to organize competing priorities, meet payer deadlines, remain calm under pressure, and lead effectively in a high-volume environment.

• Experience in laboratory, diagnostic, specialty, hospital, or physician revenue cycle operations.
• Experience with Medicare, Medicare Advantage, Medicaid, TRICARE, Veterans Affairs or Community Care Network, and commercial payer appeals.
• Experience with complex medical necessity appeals, external review, administrative escalation, regulatory complaints, or payer dispute resolution.
• Knowledge of underpayment identification, reimbursement variance analysis, payer contracts, fee schedules, or reimbursement modeling.
• Relevant certification in revenue cycle, healthcare finance, coding, billing, compliance, or leadership.

Pay range: $75,000-95,000/annually

Benefits: We offer a competitive benefits package designed to support the health, financial well-being, and work-life balance of our employees, including medical, dental, and vision insurance; Health Care and Dependent Care Flexible Spending Accounts; a 401(k) retirement savings program; 4 weeks paid time off (PTO); paid company holidays; employer-paid life insurance; optional life insurance; and employer-paid short-term and long-term disability insurance.