Lead Reimbursement Analyst

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    "description_html": "<p><strong>About Us</strong></p><p>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.</p><p><br></p><p><strong>Position Summary</strong></p><p>The Lead Reimbursement Analyst serves as a senior individual contributor within the reimbursement team, providing advanced case support while offering day-to-day guidance, subject matter expertise, and informal leadership to Reimbursement Analysts. This role bridges the gap between the Reimbursement Analyst and Reimbursement Supervisor, combining complex case management responsibilities with mentoring, quality support, and limited operational oversight. The Lead Reimbursement Analyst does not carry direct people management responsibilities but supports supervisors by helping ensure consistency, quality, and operational excellence across assigned programs. This is a fully remote, desk-based role with frequent phone and computer use.</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li><strong>Advanced Reimbursement &amp; Case Management </strong>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</li><li><strong>Leadership, Mentorship &amp; Quality Support </strong>Act as the subject matter expert and real-time resource for Reimbursement Analysts on case handling, payer policies, and program workflows; support onboarding and training of new team members including reinforcement of program-specific SOPs and business rules; assist supervisors with quality monitoring, audits, and QA activities; identify trends in errors, denials, or workflow inefficiencies and escalate findings with recommendations; assist with drafting or updating work instructions and job aids as assigned</li><li><strong>Client &amp; Cross-Functional Support </strong>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</li><li><strong>Operational Support </strong>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%</li></ul><p><strong>Qualifications</strong></p><p><strong>Education</strong></p><ul><li>Bachelor’s degree or equivalent relevant experience (Required)</li></ul><p><strong>Experience</strong></p><ul><li>Minimum 4 years of recent healthcare experience; 2 years of direct industry experience preferred (Required)</li><li>Call center experience and client interaction experience (Preferred)</li></ul><p><strong>Knowledge, Skills &amp; Abilities</strong></p><ul><li>Advanced knowledge of medical insurance (public and commercial), billing and coding, and associated terminology (Required)</li><li>Advanced written and verbal communication skills; strong customer service skills; demonstrated ability to collaborate cross-functionally and escalate issues appropriately (Required)</li><li>High attention to detail with strong data entry accuracy; advanced problem-solving, research, and analytical skills (Required)</li><li>Ability to manage time independently, prioritize workload, and multitask in a fast-paced environment; proficiency in Microsoft Office Suite (Required)</li></ul><p><strong>Work Environment</strong></p><ul><li>Location: Remote; desk-based role with frequent phone and computer use and minimal physical requirements</li><li>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</li><li>Works closely with Reimbursement Analysts, Supervisors, and Program Managers; maintains direct contact with healthcare providers, patients, payers, and client representatives</li></ul><p><strong>Employment Classification</strong></p><p>Status: Full-time &nbsp;</p><p>FLSA: Non-Exempt</p><p><strong>Equal Employment Opportunity (EEO) Statement</strong></p><p>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.</p><p><strong>Disclaimer</strong></p><p>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.</p>",
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