Supervisor – Reimbursement – Follow Up & Appeals

Supervisor – Reimbursement – Follow Up & Appeals

Requirements

• High school diploma or equivalent degree from an accredited college or university in business, healthcare administration, or related major (relevant experience may be considered in lieu of degree)
• A minimum of 3-years of experience in both professional healthcare revenue cycle management, and at least 1 year of related experience in a leadership role reflective of the level of this position
• Excellent leadership and team management skills
• Exceptional attention to detail and accuracy
• Knowledge of medical terminology, CPT, and ICD coding
• Must be proficient using a computer, PC software, specifically Microsoft Office Suite, particularly Excel, and have above average typing skills
• Excellent communication skills, both written and verbal
• Ability to effectively incorporate the mission and core values into processes and workflows
• Effective interpersonal skills to facilitate work in a team environment and to collaborate with a variety of professionals

Responsibilities

• Serve as the subject matter expert and primary resource for staff and stakeholders on compliance processes, regulations, and issues, providing guidance and clarity.
• Collaborate with Revenue Cycle Manager Leadership to proactively audit claims and collections across all third-party payers—including Medicare, managed care, commercial insurance, and patient payments—to ensure accuracy and maximize cash flow.
• Assure maximization of cash collections through organized, diligent and timely focused monitoring of all open accounts’ receivable balances.
• Analyze reimbursement data from various sources, review carrier exception reports, and follow up on pending claims and denials, presenting findings to leadership and developing action plans to mitigate risks.
• Prepare comprehensive reports on billing activities, accounts receivable metrics, bad debt expenses, and days outstanding to support continuous process improvements.
• Conduct audits of billing records to verify data accuracy and completeness, including payment posting and contractual adjustments.
• Assist in developing and maintaining department Standard Operating Procedures (SOPs) aligned with CLSI guidelines, ensuring staff adherence to policies and deadlines.
• Evaluate key performance indicators (KPIs), provide performance feedback, and support staff development and coaching for accurate documentation and timely claim submissions.
• Facilitate onboarding, training, and updates to training materials, workflows, and change management strategies to foster an efficient, compliant revenue cycle environment.
• Follow HIPAA and other regulatory guidelines diligently to protect patient information and ensure confidentiality.
• Performs other related duties as assigned to support the overall efficiency of the department.

Preferred Qualifications

• Knowledge in managed care requirements as they relate to reimbursement, knowledge of US Commercial, Medicare, Medicaid and third-party payer reimbursement preferred
• Experience with contacting and follow-up with insurance carriers, file reconsideration requests, formal appeals and negotiations (preferred)
• Familiarity with laboratory billing, Xifin, Telcor, payer portals and national as well as regional payers throughout the country is a plus