RCM Supervisor, Project Management - remote
Description
The Revenue Cycle Supervisor is responsible for overseeing the daily operations of the reimbursement team, with a specialized focus on Payor escalations, Legal escalations & credit review. This role ensures timely and accurate collection of outstanding accounts receivable across Pharmacy, Home Infusion, and Specialty product lines. The Supervisor leads efforts to identify, escalate, and resolve complex reimbursement issues, including those requiring Legal review or escalation to Payor Contacts, and ensures proper handling of credit balances and refund processing in accordance with payer guidelines and compliance standards.
Required Knowledge, Skills & Training
• Bachelors Degree required, advanced degree preferred.
• Minimum of five years of professional business experience with significant accomplishments and track record in achieving coding, coverage and payment for medical services and developing new reimbursement support programs and services.
• Minimum of five years’ experience working directly with managing reimbursement strategy and tactical execution including managing reimbursement support in the medical environment and or reimbursement consulting.
• Thorough knowledge and understanding of the pharmaceutical reimbursement environment (government and private payers) including coverage, coding and payment as well as how to develop, implement and manage reimbursement assistance programs preferred.
• Exceptional analytical and problem-solving skills and ability to work independently to develop effective reimbursement strategy and tactical programs/tools strongly preferred.
• Strong interpersonal skills to influence/negotiate complex decisions and be a strong positive advocate for communicating the mission, objectives and results of the Accounts Receivable Team with stakeholders and building cross-functional relationships.
• High level of verbal and written communication skills, credible with high level audience.
• Strong analytical and business skills.
• Supervise and coach team members in daily reimbursement activities, ensuring productivity and compliance.
• Lead the identification and escalation of high-dollar or complex payer issues to Legal and Payor Escalation teams, including Contracting and RCM Leadership.
• Oversee credit balance reviews to ensure accurate identification of overpayments and timely resolution.
• Manage refund processing workflows, ensuring compliance with payer requirements and internal policies.
• Collaborate with Legal on payer disputes, appeals, and contract interpretation impacting reimbursement.
• Monitor and report on legal escalations, including timelines, outcomes, and payer trends.
• Ensure adherence to HIPAA, regulatory, and contractual obligations in all reimbursement activities.
• Develop and implement training programs to educate staff on legal escalation protocols, credit review procedures, and payer dispute processes.
• Partner with internal departments (Finance, Contracting, Legal) to resolve reimbursement barriers and refund-related issues.
• Maintain documentation and audit trails for all escalated cases, credit reviews, and legal correspondence.
• Analyze reimbursement trends and proactively identify areas of risk or non-compliance.
• Serve as a liaison between the reimbursement team and external legal.
- BCBSL Medical
- Delta Dental
- EyeMed Vision
- 401k
- Accident & Critical Illness
- Life Insurance
- PTO, Holiday Pay, and Floating Holidays
- Tuition Reimbursement