Lead Reimbursement Analyst

Description

About Us

At Gifthealth, we’re revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We’re a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people’s lives.

Position Summary

The Lead Reimbursement Analyst serves as a working team lead within the reimbursement organization, combining advanced reimbursement expertise with direct people leadership responsibilities. This role manages a team of Reimbursement Analysts while maintaining ownership of complex reimbursement cases, escalations, quality initiatives, and operational performance. The Lead Reimbursement Analyst is responsible for coaching, developing, and supporting team members, ensuring adherence to client requirements, quality standards, and service level expectations. This role partners closely with leadership to drive operational excellence, employee engagement, and continuous process improvement. This is a fully remote, desk-based role with frequent phone and computer use.

Key Responsibilities

• Advanced Reimbursement & Case Management Serve as the primary point of contact for moderate to complex reimbursement cases including insurance benefit investigations, prior authorizations, appeals, and patient assistance programs; manage and resolve escalated cases requiring advanced research, payer interaction, or clinical coordination; review and resolve denied or underpaid claims; research and apply payer medical policies, prior authorization requirements, and coverage guidelines; identify patient-specific insurance coverage options; reverify patient benefits at predetermined timeframes and document all activities within required timelines
• Leadership, Mentorship & Quality Support Provide direct supervision, coaching, and performance management for a team of Reimbursement Analysts, including goal setting, performance feedback, and employee development; conduct regular one-on-one meetings, performance discussions, and career development planning; support recruiting, interviewing, onboarding, and training of new team members; monitor team productivity, quality, and service level metrics and implement corrective actions as needed; serve as the primary escalation point for complex reimbursement cases and operational issues; act as a subject matter expert and resource for reimbursement workflows, payer policies, and client requirements; identify trends in errors, denials, or workflow inefficiencies and implement solutions to improve team performance; assist with drafting, maintaining, and communicating SOPs, work instructions, and quality standards; foster a positive, collaborative, and accountable team environment.
• Client & Cross-Functional Support Serve as a point of contact for internal teams and external stakeholders including payers, healthcare providers, patients, and client representatives; may act as a regional or program-specific contact for senior-level client contacts; assist with coordination of tasks and communication between Gifthealth, clients, and internal partners; prepare or assist with preparation of internal and client-facing reports including adverse event and product complaint documentation as required
• Operational Support Monitor and communicate updates related to payer policies, coverage changes, and prior authorization requirements; assist in testing and feedback for CRM, telephony, and system tools related to reimbursement workflows; participate in client calls, meetings, off-site trainings, and conferences as needed; travel estimated at up to 5%

Qualifications

Education

• Bachelor’s degree or equivalent relevant experience (Required)

Experience

• Minimum 4 years of recent healthcare/medical & billing experience with at least 1-2 years of leadership, supervisory, team lead, or people management experience preferred (Required)
• 2 years of direct reimbursement, specialty pharmacy, hub services, or patient support program experience preferred (Required)
• Call center experience, client interaction experience, and experience leading or mentoring team members (Preferred)
• Active Pharmacy Technician Trainee license or ability to obtain one within 90 days of hire (Required)

Knowledge, Skills & Abilities

• Advanced knowledge of medical insurance (public and commercial), billing and coding, and associated terminology (Required)
• Advanced written and verbal communication skills; strong customer service skills; demonstrated ability to collaborate cross-functionally and escalate issues appropriately (Required)
• High attention to detail with strong data entry accuracy; advanced problem-solving, research, and analytical skills (Required)
• Ability to manage time independently, prioritize workload, and multitask in a fast-paced environment; proficiency in Microsoft Office Suite (Required)

Work Environment

• Location: Remote; desk-based role with frequent phone and computer use and minimal physical requirements
• Schedule: Monday through Friday, 8:00 AM to 8:00 PM EST (40 hours/week); shift start times may range from 8:00 AM to 11:00 AM EST; occasional weekend hours may be required to support client needs
• Works closely with Reimbursement Analysts, Supervisors, and Program Managers; maintains direct contact with healthcare providers, patients, payers, and client representatives

Employment Classification

Status: Full-time

FLSA: Non-Exempt

Equal Employment Opportunity (EEO) Statement

Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.