Reimbursement Manager

SCP Health•Lafayette, LA

1d•$65,464 - $96,904•Onsite

About The Position

The Revenue Assurance Manager manages both stateside and offshore teams, ensuring team objectives align with and exceed SCP’s organizational goals. The role requires ongoing collaboration with Leadership, Managed Care, Accounts Payable, and Offshore teams to identify, analyze, and track payer behavior, claims activity, and underpayment trends.

Requirements

Demonstrates strong initiative and attention to detail while independently managing projects and providing clear, concise status updates, including progress, risks, and issues to stakeholders and management.
Exhibits a high degree of creativity and judgment to develop innovative solutions and accomplish objectives effectively.
Leverages industry knowledge and professional experience to plan strategically and achieve goals.
Excels in both verbal and written communication, capable of conveying complex information clearly and persuasively.
Skilled in collecting, interpreting, and analyzing complex datasets to inform decision-making and drive outcomes.
Exercises considerable individual judgment and initiative to conduct operations efficiently within established programs.
Prepare and deliver presentations to diverse audiences, including executive leadership.
Coordinate project activities across varied groups and stakeholders to ensure alignment and timely completion.
Maintains professionalism, positivity, and consistency when responding to challenging or stressful situations.
Ability to manage multiple projects simultaneously while demonstrating strong leadership and organizational skills.
Proficient in Microsoft Office Suite and other relevant software tools essential for data analysis and reporting.
Organized with the ability to prioritize tasks, manage time effectively, and work independently to meet deadlines.
Strong interpersonal skills with a focus on fostering positive relationships and delivering excellent customer service.
Solid understanding of healthcare reimbursement processes, particularly as they relate to emergency medicine.
Committed to adhering to productivity targets and departmental policies to drive consistent, high-quality results.
5 years’ experience in the health care preferably in billing or appeals & denials.
Experience in Emergency Medicine billing and/or Healthcare reimbursement
Experience in Managed Care and Payer auditing and reporting

Nice To Haves

Bachelor’s degree or equivalent health care work experience

Responsibilities

Lead and manage the reimbursement variance, arbitration, and appeals teams (both stateside and offshore), ensuring alignment with organizational goals and KPIs.
Plan, organize, and direct work activities to ensure quality outcomes and high production standards.
Conduct performance evaluations and mentor staff to support professional development and performance improvement.
Foster a culture focused on customer service, operational efficiency, accountability, and continuous improvement.
Regularly review key performance indicators (KPIs), making adjustments as necessary to optimize performance and increase recoveries.
Oversee the appeals lifecycle, including contracted, non-contracted, and downcoded appeals—with a focus on accuracy, timeliness, and compliance.
Manage the processing, collection, and submission of federal and state arbitration invoices, ensuring adherence to deadlines and payment timelines.
Coordinate and balance arbitration workflows between stateside and offshore teams to maintain targets and quality standards.
Research conflicting arbitration data and/or decisions to ensure fair resolution and accurate reporting.
Identify trends in reimbursement and appeal outcomes; develop new strategies and revise processes to maximize recoveries.
As needed, communicate and coordinate with vendors and external partners to implement cost-saving and efficiency measures.
Analyze and summarize audit results on a monthly basis; present key findings and performance metrics through Emergency Department (ED) and Managed Care Monthly Operating Reviews (MORs).
Monitor and analyze inventory and appeal trends to ensure department goals and targets are met.
Maintain and update database system logic to ensure the accurate identification of appeal opportunities and recovery potential.
Perform data management functions including letter development, audit tracking, and system logic updates to support end-to-end recovery operations.
Work with Compliance to ensure compliance with SOX audit requirements and regulatory changes affecting appeals and arbitration.
Maintain and oversee the accuracy of reimbursement systems including the Managed Care Contract Database and Athena platform.
Participate in automation and efficiency initiatives across arbitration and non-contracted appeals processes.
Continuously look for ways to reduce costs, enhance workflows, and improve appeal turnaround times.
Collaborate with Leadership, Managed Care, Accounts Payable, Offshore and other department as required on identified issues and resolution strategies.
Coordinate directly with managed care plans to resolve claims discrepancies and drive recovery success.