Reimbursement Supervisor

This role oversees a team of specialists to ensure accurate claim submissions, payment collections, compliance with payer and regulatory requirements, and timely resolution of billing issues. The Reimbursement Manager also plays a key role in training, workflow optimization, and payer communication to ensure the financial health of the organization.

Benefits:

• Competitive salary
• Flexible schedule
• Paid time off
• Training & development

Job Title: Reimbursement Manager
Department: Revenue Cycle / Billing
Reports To: CEO
Job Type: Full-Time
Location: McKinney, TX


Position Summary:


The Reimbursement Manager is responsible for leading and supervising all aspects of the reimbursement and medical billing process. This role oversees a team of specialists to ensure accurate claim submissions, payment collections, compliance with payer and regulatory requirements, and timely resolution of billing issues. The Reimbursement Manager also plays a key role in training, workflow optimization, and payer communication to ensure the financial health of the organization.


Key Responsibilities:

• Supervise daily operations of the reimbursement team including claim submission, billing edits, denials, and collections.
• Ensure timely and accurate submission of claims (electronic and paper) with appropriate documentation (e.g., DIFs, DWOs, LOAs).
• Monitor and improve reimbursement processes and metrics such as days in A/R, denial rates, and collection effectiveness.
• Review and ensure proper use of billing codes (HCPCS, CPT, ICD-10), NDC units, J-codes, and Place of Service.
• Resolve escalated issues related to front-end denials, payer rejections, and complex reimbursement discrepancies.
• Oversee setup and maintenance of payers in the billing system.
• Maintain up-to-date knowledge of Medicare, Medicaid, commercial payer guidelines, and specialty pharmacy/home infusion billing requirements.
• Coordinate billing and follow-up for third-party payers, co-pay assistance programs, foundations, and manufacturer support programs.
• Oversee documentation for refunds to payers or patients and coordinate payment information with cash posting staff.
• Audit delivery tickets and ensure eligibility for financial assistance programs.
• Review and approve patient hardship waivers; maintain tracking and documentation.
• Compile and analyze reimbursement reports for leadership and make recommendations for improvement.
• Train and support staff on billing procedures, system updates, and payer changes.
• Ensure compliance with all federal, state, and local billing regulations.

Qualifications:


Required:

• Bachelor’s degree in Healthcare Administration, Finance, or related field; or equivalent experience/certification (Medical Billing Certificate acceptable).
• 5+ years of medical billing or reimbursement experience, preferably in home infusion or specialty pharmacy.
• Strong understanding of coding (CPT, HCPCS, ICD-10), insurance claim submission, and billing workflows.
• Knowledge of federal/state billing guidelines, including Medicare and commercial payer requirements.
• Experience with electronic claim transmissions, clearinghouses, and denial management.
• Proficiency in Microsoft Excel, Word, Outlook.
• Strong math skills, including unit conversions (e.g., grams to milligrams).
• Excellent communication, problem-solving, and organizational skills.

Preferred:

• Knowledge of home infusion, specialty infusion, and pharmacy billing practices.
• Experience with reimbursement support programs and co-pay assistance.
• Familiarity with HCFA 1500 claim requirements.
• Prior supervisory or leadership experience in a billing/reimbursement setting.

Working Conditions:

• Must be able to work flexible hours as needed based on business demands.