The Reimbursement Manager will oversee daily operations of reimbursed activities by working closely with the Associate Director of Reimbursement to implement business strategy through efficient management of our workflow and work cross-functionally across departments to meet strategic objectives. Through collaboration with staff, the director will identify internal and external customers and their expectations, to initiate process changes that will increase quality, decrease costs and that will improve staff, managed care plans and patient satisfaction. The leader will also assist in the establishment of departmental strategies, objectives, quality improvement initiatives that eliminate inefficiencies and improve ROI by evaluating new processes.

Overall Responsibilities

• Leads and Manages daily team operational workflows
• Submission of documentation requests to physicians
• Successful receipt of medical records/documentation/prescriptions from physicians
• Timely and accurate verification of patient benefits across all payers (Medicare, Medicaid, commercial insurance)
• Timely response to audit/medical record requests
• Documentation management
• Ensures workflows are in compliance with related laws, regulations and company directives
• Utilizes a data driven approach to oversee all workflows of the department that will maximize both production and quality standards
• Analyzes reports, records, and other metrics to confer with staff for efficient planning and staff utilization
• Create new and evolve current processes by identifying opportunities through available reporting metrics to improve profitability and patient satisfaction
• Proactively builds and implements key KPI’s to increase quality, financial performance (and service levels

Experience Required

• 5-10+ years of operations experience managing/supervising in operations within healthcare industry
• Thorough knowledge and experience of the rules and regulations associated with managed care, insurance, Medicare and Medicaid.
• Experience working in a matrix organization with the ability to manage multiple priorities across various stakeholders and departments
• Advance computer skills and proficiency in MS Excel required; intermediate skills and proficiency in Outlook and PowerPoint required
• Demonstrate a thorough knowledge of the rules and regulations associated with Medicare, Medicaid and commercial insurance organizations

Mission Critical Skills

• Strong leadership acumen; problem solving skills, successful team management and development
• Demonstrated strong analytical, quantitative, and logical thinking skills
• Extensive problem-solving capabilities
• Strong written and verbal communication skills
• Attention to details and accuracy along with strong organization skills