Job Description
The Program Reimbursement Manager is responsible for leading and optimizing reimbursement operations across the organization’s programs and services. This position oversees claims processing, denial management, reimbursement performance, regulatory compliance, and revenue optimization. The Manager leads and develops the reimbursement team, monitors key performance indicators, identifies opportunities to reduce revenue leakage, and partners with internal and external stakeholders to ensure timel…
7:30 AM
Log in and pull the overnight denial queue. Your worklist shows 40–80 claims flagged by the payer in the last 24 hours. Sort by do…
8:00 AM
Start working the queue. For each denial, you're reading the remittance advice, identifying the denial reason code (CO-4, CO-50, C…
9:30 AM
Hit a complex medical necessity denial from a Medicare Advantage plan. Open the patient chart, pull the clinical documentation, an…
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