Job Type
Full-time
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 PromptCare In-home Respiratory and Infusion
Reports to: Vice President, Revenue Cycle Management
Job Type: Exempt, Full/Time
Requirements
- 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, NikoHealth, 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
Job Responsibilities, included but not limited to:- 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, overpayments, 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 and reduce outstanding receivables.
- Collaborate with intake, sales, customer service, operations, and finance to ensure accurate patient information, timely documentation, and clean claim submission.
- Support audits, appeals, payer reviews, and documentation requests.
- Train, coach, and mentor team members on DME billing rules, payer requirements, system workflows, and best practices.
- Participate in system improvements, process redesign, automation opportunities, and policy development.
- Maintain accurate account notes, documentation, and audit trails for all collection and resolution activities.
- Perform other duties as assigned.
Physical DemandsThe physical requirements listed here indicate what an employee must meet to effectively perform this role's essential functions. The employee frequently needs to communicate verbally, listen attentively, and spend prolonged periods sitting at a desk and working on a computer. The role also requires lifting files, opening filing cabinets, and bending or standing as needed.
Benefits & Perks- Comprehensive Medical, Dental, and Vision Package
- 401(k) Plan with Company Match
- Generous PTO: Vacation, Sick Time, Personal Days, and Paid Holidays
- Life Insurance: Standard coverage with optional enhancements
- Employee Assistance Program: Free counseling and coaching sessions
- Emotional Well-being and Work-Life Balance Resources
- Short & Long-Term Disability: Company-paid with optional supplements
- Accidental Death and Dismemberment Insurance
- FSA and HSA: Manage healthcare expenses
- Commuter Spending Programs
- Volunteer and Engagement Opportunities
- Exclusive Discounts on entertainment, travel and various other supplemental and cellphone plans
