Reimbursement Supervisor

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.