Reimbursement Manager

HealthDrive•Framingham, MA

2d•Hybrid

About The Position

HealthDrive is seeking a full-time Reimbursement Manager to join our team! As a Reimbursement Manager within our Revenue Cycle Department, you will play a pivotal role in leading our Accounts Receivable team toward achieving our Revenue Cycle Key Performance Indicators (KPIs) for denial management, cash collections, bad debt and DSO objectives. Your hands-on leadership will be instrumental in maximizing revenue opportunities, resolving denial issues and fostering a positive work environment. This role is in person 5-days a week at our Framingham, MA office. There is potential for 2-days hybrid following the first 6 months of employment.

Requirements

Strong organizational, leadership, and interpersonal skills.
Excellent analytical, problem-solving, and prioritization skills.
Strong time management skills with the ability to adapt to change and multitask effectively.
Excellent written and verbal communication skills, with a hands-on leadership approach and strong work ethic.
Ability to hire, develop, and mentor staff for optimal performance.
Ability to analyze processes, systems, and implement changes to improve staff efficiency and results.
Willingness to work additional hours on a daily basis to ensure business objectives are achieved.
Proficiency in Microsoft Office applications (Excel, Outlook, and Word).
Relevant Associate’s Degree or equivalent combination of education and work experience.
7+ years of experience in healthcare billing and collections, with at least 5 years of supervisory or management experience.
Extensive knowledge of Medicare, Medicaid, and third-party insurance plan requirements and regulations for physician billing, denial resolution management, and insurance eligibility.

Nice To Haves

Prior managerial experience of a minimum of 3 years, preferably of team(s) of 8+.
Experience from large volume multi-specialty physician practice providing services to patients in Post Acute Care setting.
Experience managing RCM vendor relationships.

Responsibilities

Lead and oversee the Accounts Receivable staff to ensure consistent follow-up and resolution of unpaid, incorrectly, or partially paid and denied medical and dental claims for services provided in Post Acute care setting.
Ensure timely identification and resolution of payer denial trends; work closely with payer provider relations, claims processing management, and other departments as required by the payers to resolve denial and incorrect payment issues.
Provide hands-on training and daily support to staff on systems and processes to address and resolve AR-related issues daily.
Review and improve processes to increase staff and system efficiency to ensure achievement of Revenue Cycle Key Performance Indicators (Minimize upfront claim rejections and denials, bad debt write-offs, reduce DSO and increase daily cash collections).
Educate staff on compliant actions for resolving Medicare, State Medicaid, and third-payer payer claim issues.
Review outstanding AR balances regularly, make recommendations for bad debt, and ensure timely adjustment processing.
Implement enhanced productivity and quality measurement tools for the Accounts Receivable area.
Foster a positive, team-oriented, and inclusive work environment, building confidence and trust among team members.
Effectively communicate goals and objectives to team members, monitoring progress daily.
Provide extensive hands-on training to new staff and ongoing development for existing employees on systems, payer requirements, and policies.
Manage RCM external vendor relationships.
Develop and implement standardized policies and procedures and programs for onboarding and retraining; including detailed training manual for denial resolution management, appeals and other AR related tasks.
Evaluate employee performance, provide ongoing feedback, draft annual performance reviews, and conduct review meetings, implementing performance improvement plans as needed.
Demonstrate strategic thinking, prioritize tasks, manage multiple projects, and allocate resources effectively as required.
Assist with various projects and month-end close processes to meet business objectives.
Perform other duties and tasks as assigned as appropriate or necessary.