Manager, Claims Processing

Role Overview

• Oversee the review, adjudication, and resolution of home health, DME, home infusion and SNF claims, including Medicare, Medicaid, and commercial payer claims, ensuring compliance with payer guidelines, CMS regulations, and organizational policies.
• Determine whether claims are paid, denied, returned, or adjusted based on clinical documentation, coding accuracy, authorization status, and payer requirements.
• Manage escalated, complex, or high-risk claims issues, including denials, underpayments, and payer disputes.
• Manage and develop claims processing professionals and/or claims supervisors; set performance expectations, provide coaching, and conduct performance reviews.
• Identify, lead, and implement change initiatives to improve claims processing efficiency, denial rates, turnaround times, and cash flow.
• Collaborate with Coding, Clinical Operations, Intake, Authorization, Finance, and Compliance teams to ensure accurate documentation and clean claim submission.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field, or equivalent combination of education and experience.
• 5+ years of progressive experience in claims processing, billing, or revenue cycle management within home health, DME, home infusion, SNF or related healthcare settings.
• 2 or more years of people management experience
• Comprehensive knowledge of all Microsoft Office applications, including Word, Project and Visio
• Strong working knowledge of Medicare, Medicaid, and commercial insurance reimbursement, EDI claims, and healthcare billing systems

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance and many other opportunities