Full-Time Reimbursement Manager

Purpose: The Reimbursement Manager is responsible for overseeing the reimbursement processes for Lingraphica’s products and services. This role ensures efficient and compliant operations within the Revenue Cycle Management (RCM) team, optimizing reimbursement workflows, claim submissions, denials management, and payer relationships. The ideal candidate has a strong background in healthcare reimbursement, insurance authorizations, billing, and compliance, with a focus on process improvement and operational efficiency.

Essential Duties and Responsibilities:

1. Claims & Reimbursement Operations: Oversee the end-to-end reimbursement process, including claim submission, follow-ups, appeals, and denials management. Ensure timely and accurate billing to private insurers, Medicare, Medicaid, and other payers. Develop and implement strategies to optimize reimbursement rates and reduce claim denials. Monitor reimbursement trends, payer policies, and regulatory updates to ensure compliance.
2. Process Optimization & Compliance: Identify opportunities for workflow improvements within the reimbursement function. Collaborate with internal teams (Funding, Contracts, Customer Support) to streamline reimbursement processes. Ensure adherence to all payer guidelines, HIPAA, and compliance requirements. Provide training and guidance to team members on reimbursement best practices and policies.
3. Stakeholder Management: Serve as a key point of contact for reimbursement-related escalations and disputes. Work closely with internal stakeholders to improve communication between Revenue Cycle, Sales, and Customer Support teams. Performs quarterly and annual reviews for the Reimbursement team. Conducts weekly Reimbursement team meetings. Performs weekly 1-1 meetings with direct reports. Provides on-going performance feedback, addresses problems, determines staffing needs, interviews and hires staff, orients and trains employees, verifies competency and identifies and suggests ways to develop skills.
4. Data & Reporting: Track and analyze reimbursement performance metrics, including claim acceptance rates, denial rates, and reimbursement timelines. Generate reports to provide insights into reimbursement trends, opportunities, and financial impacts. Develop action plans based on data-driven insights to improve overall reimbursement efficiency.

Qualifications & Experience: 5+ years of experience in healthcare reimbursement, medical billing, or revenue cycle management. Leadership experience with the ability to manage and mentor team members effectively. Strong knowledge of Medicare, Medicaid, private insurance, and payer reimbursement policies. Experience with claims processing, denials management, and appeals. Familiarity with healthcare compliance regulations (HIPAA, CMS guidelines, etc.). Proficiency in billing and reimbursement software, electronic health records (EHR), and reporting tools. Strong analytical, problem-solving, and communication skills.

Work Environment & Physical Demands: Employee works from home and is expected to maintain a safe, productive work environment with secure internet access. Must be able to operate a computer with or without reasonable accommodation.

Travel: Travel is required to Princeton, NJ or another location within the US for meetings approximately 2x / year. Other occasional travel may be needed if business needs arise.

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