Lead Reimbursement Analyst, Healthcare & Billing
Overview
Own complex reimbursement cases and a team of Reimbursement Analysts at Gifthealth, a healthcare technology company scaling patient support programs. You'll combine advanced payer expertise with people leadership, driving quality, performance, and process improvement. This fully remote role sits at the intersection of clinical coordination and operational excellence, with direct impact on patient access to medications.
What You'll Do9
- 1Manage moderate to complex reimbursement cases including insurance benefit investigations, prior authorizations, appeals, and patient assistance programs, resolving escalations with advanced research and payer interaction.
- 2Review and resolve denied or underpaid claims, applying payer medical policies and coverage guidelines to identify patient-specific insurance options and reverify benefits within required timelines.
- 3Supervise, coach, and develop a team of Reimbursement Analysts, setting goals, providing feedback, and conducting performance reviews and career development plans.
- 4Monitor team productivity, quality, and service level metrics, implementing corrective actions to meet client requirements and service level expectations.
- 5Serve as the primary escalation point for complex cases and operational issues, acting as a subject matter expert on reimbursement workflows and payer policies.
- 6Identify trends in errors or denials and implement solutions to improve team performance; draft and maintain SOPs, work instructions, and quality standards.
- 7Collaborate with internal teams and external stakeholders including payers, healthcare providers, patients, and client representatives, preparing reports on adverse events and product complaints.
- 8Monitor and communicate updates on payer policy changes and prior authorization requirements, and assist in testing CRM and telephony systems.
- 9Participate in client calls, meetings, and off-site trainings as needed, with travel up to 5%.
Requirements8
- 14+ years of healthcare/medical billing experience, with 1-2 years in a leadership or supervisory role.
- 22+ years in direct reimbursement, specialty pharmacy, hub services, or patient support programs.
- 3Active Pharmacy Technician Trainee license or ability to obtain within 90 days of hire.
- 4Bachelor's degree or equivalent relevant experience.
- 5Advanced knowledge of medical insurance (public and commercial), billing and coding, and associated terminology.
- 6Proficiency in Microsoft Office Suite.
- 7Call center experience and client interaction experience preferred.
- 8Experience leading or mentoring team members preferred.
Salary Insight
$64 - $81k per year
Location
Required Skills
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