Confidential

Compensation

Full Description

Position Summary The Reprocessing Claims Manager is a critical leadership role within the company's Revenue Cycle team, responsible for overseeing the resolution of denied, underpaid, or misprocessed claims. This individual ensures accurate and timely reprocessing through expert analysis, effective communication, and proactive escalation when necessary. The manager must demonstrate strong documentation skills, critical thinking, and sound judgment on when to escalate payer issues to legal. They will also lead efforts to improve claims processes, maximize reimbursement, and ensure regulatory compliance. Key Responsibilities Leadership • Manage and mentor a team of claims reprocessing specialists • Set clear performance goals and ensure adherence to timelines and quality benchmarks • Evaluating current KPI’s as well as creating new ones throughout efficiency changes and company growth • Provide ongoing training on payer rules, appeal processes, system updates, and for new employees • Managing current processes while simultaneously looking to increase efficiencies Claims Reprocessing • Oversee: Review, Correction, and Resubmission of denied or misprocessed claims • Ensure accurate coding, modifier usage, and billing logic per ABA and insurance guidelines • Maintain detailed documentation of all claim actions and resolutions Communication & Escalation • Serve as the primary point of contact for escalated issues • Communicate professionally with insurance representatives, internal departments, and external partners • Identify and escalate complex or high-risk cases to the legal team when appropriate Documentation & Analysis • Ensure meticulous documentation of reprocessing activities, appeal letters, and payer correspondence • Conduct root cause analysis on denial trends and recommend systemic improvements • Collaborate with the authorization, scheduling, and clinical teams to prevent recurring issues Reporting & Compliance • Generate regular reports on denial rates, reprocessing outcomes, and recovery metrics • Maintain compliance with HIPAA and payer-specific billing rules • Assist with audit preparation and internal quality reviews Required Skills • Exceptional communication skills — verbal and written, including professional correspondence with payers • Strong documentation practices with audit-ready accuracy • Critical thinking and problem-solving abilities to analyze denials and develop resolution plans • Ability to identify when legal escalation is necessary and document the justification • Proficient in billing and RCM software (e.g., CentralReach, Kareo, or similar) and clearinghouse platforms • Solid understanding of HIPAA, CMS, and payer-specific compliance requirements • Outbound/Inbound Calling w/ Payor Groups Qualifications • Bachelor’s degree in Healthcare Administration, Business, or related field (preferred) • 5+ years of experience in Revenue Cycle Management (RCM), with direct experience handling health insurance claims • Behavioral health or ABA settings preferred • Strong knowledge of ABA billing, CPT codes, modifiers, and payer authorization requirements • Proven track record of resolving high-volume denials and maximizing reimbursement Job Type: Full-time Pay: $75,000.00 - $90,000.00 per year Benefits: • 401(k) • Dental insurance • Health insurance • Paid time off • Vision insurance Work Location: Remote