Manager of Reimbursement

Role Description

We are seeking a Manager of Reimbursement to lead and manage day-to-day reimbursement operations, including oversight of a team of three Lead Reimbursement Analysts. This position plays a key role in supporting the Reimbursement and Revenue Cycle function, ensuring alignment with organizational goals, operational excellence, and compliance standards. Each Lead Reimbursement Analyst manages their own team of Reimbursement Analysts, so this role provides leadership through the Leads, sets direction across the broader reimbursement function, and serves as the escalation point for issues beyond the Leads' scope, spanning benefit investigations, prior authorizations, appeals, and patient assistance programs within Gifthealth's hub services and specialty pharmacy programs. This is a fully remote, desk-based role with frequent phone and computer use.

Key Responsibilities

• Direct and oversee reimbursement operations across the team, including benefit investigations, prior authorizations, appeals, denials management, and patient assistance programs, to maximize timely and accurate reimbursement.
• Directly manage and mentor three Lead Reimbursement Analysts, setting priorities, monitoring team performance, and supporting their professional development.
• Serve as the final point of escalation for reimbursement cases and operational issues that exceed the scope or authority of the Lead Reimbursement Analysts.
• Monitor reimbursement KPIs (e.g., days sales outstanding, denial rates, collection rates) and develop action plans to address performance gaps.
• Ensure compliance with payer contracts, coding guidelines, and applicable state and federal reimbursement regulations.
• Partner cross-functionally with Finance, Billing, Coding, and Payer Relations to identify and resolve reimbursement barriers.
• Prepare and present regular reimbursement performance reports and forecasts to senior leadership.

Qualifications

• Education: Bachelor's degree in Healthcare Administration, Business, Finance, or a related field, or equivalent experience.
• Licensure/Certification: Pharmacy Tech Trainee license required.
• Experience: 6+ years of experience in healthcare reimbursement, specialty pharmacy, hub services, or patient support programs, including 3+ years managing people leaders (e.g., leads, supervisors, or managers).
• Skills:
  • Strong knowledge of payer reimbursement methodologies, benefit investigations, prior authorizations, appeals, denials management, and patient assistance programs within a specialty pharmacy or hub services environment.
  • Experience with reimbursement, CRM, and telephony systems, and advanced proficiency in Excel and reporting tools.
  • Proven ability to lead and develop people leaders, and to drive performance across distributed, fully remote teams.
  • Strong understanding of healthcare reimbursement, payer policy, and revenue cycle management.
  • Excellent leadership, communication, and data-driven decision-making skills.

Desired Attributes

• Detail-oriented and highly organized, with strong analytical and problem-solving skills.
• A collaborative, coaching-oriented leadership style.
• Comfortable operating in a fast-paced, evolving healthcare environment, and skilled at building team culture and engagement in a fully remote setting.

Work Environment

• Location: Hybrid
• Schedule: Full-time
• May require additional availability during specific hours or days or flexibility for escalations.
• Regular meetings with your teams, department, or leadership to ensure alignment.

Key Essential Functions

• Must be able to sit and work at a computer for extended periods.
• Must be able to occasionally lift up to 15 pounds (e.g., files, office supplies).
• Must be able to perform tasks requiring extended computer and telephone use, including typing, calls, and reviewing on-screen data.
• Must be able to work in a fully remote, desk-based capacity with a reliable, secure home workspace and internet connection.

Employment Classification

• Status: Full-time
• FLSA: Exempt

Equal Employment Opportunity (EEO) Statement

Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.