Billing Manager

GENERAL PURPOSE: The Billing Manager is responsible for overseeing the full spectrum of Revenue Cycle Management (RCM) activities, ensuring accurate billing and timely reimbursements in alignment with organizational policies and payer-specific guidelines. This role requires collaboration with clinical, medical, administrative, and quality assurance teams to address billing concerns, resolve discrepancies, and optimize revenue flow.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Revenue Cycle Management:

• Oversee day-to-day billing operations, including charging, payment posting, accounts receivable (A/R) management, denial resolution, and audits.
• Ensure accurate and timely submission of claims to third-party payers and follow up on outstanding claims within the standard billing cycle.
• Perform detailed reviews of insurance payments for compliance with contract terms and accuracy, and initiate appeals for low reimbursements or discrepancies.
• Develop and maintain systems for tracking and addressing claim denials, underpayments, and audits to maximize revenue.
• Submit claims to insurance companies accurately and timely, ensuring compliance with payer requirements.
• Monitor and manage claim statuses, following up on unpaid or denied claims to ensure timely resolution.
• Review and reconcile Explanation of Benefits (EOBs) to verify proper payments and identify underpayments or discrepancies.
• Appeal denied or underpaid claims with supporting documentation and track the outcomes to completion.
• Accurately post payments from insurance companies, patients, and other payers to the appropriate accounts.
• Generate and review patient invoices, ensuring accuracy and completeness of charges.
• Communicate with patients to explain billing processes, resolve billing inquiries, and set up payment plans as necessary.
• Verify insurance eligibility and benefits for patients to ensure appropriate billing and coverage.
• Update and maintain billing software systems with the latest payer requirements, contracts, and fee schedules.
• Perform account audits to identify errors in billing, payments, or adjustments, and correct them promptly.
• Track and report on accounts receivable (A/R) metrics, providing regular updates to leadership on collections and outstanding balances.
• Collaborate with clinical and administrative teams to ensure accurate documentation supports billing requirements.
• Conduct monthly reconciliation of billing and payments to ensure proper alignment of financial records.
• Stay updated on changes in insurance policies, coding standards, and billing regulations to maintain compliance.

2. Policy and Procedure Development:

• Adhere to and enforce organizational billing policies and procedures.
• Collaborate with the Executive Director to review and update billing policies to ensure alignment with payer-specific practices and optimize workflows.
• Document and implement updates to policies and procedures in real-time as workflow changes occur.

3. Collaboration and Communication:

• Act as the primary liaison for billing-related issues across departments, including clinical, medical, administrative, and quality assurance teams.
• Work with the Executive Director to resolve complex issues such as audits, third-party payer negotiations, and denial management.
• Educate staff on billing practices and workflows to improve efficiency and accuracy across the organization.
• Coordinate with clinical staff to ensure timely updates of patient charts for compliance with state and billing regulations.

4. Customer Service:

• Address and resolve patient and customer billing inquiries by explaining billing practices, insurance coverage, and payment options in a professional and empathetic manner.
• Provide clear guidance to patients regarding coinsurance, deductibles, and financial obligations.

5. Reporting and Auditing:

• Regularly review accounts for insurance and patient follow-ups, and ensure compliance with billing policies and payer requirements.
• Generate reports on key metrics such as A/R, denials, reimbursement rates, and payment trends to support organizational decision-making.

6. Administrative and Team Support:

• Assist in verification of benefits (VOB) as needed, acting as a backup resource for complex cases or when inconsistencies arise.
• Process medical record requests in compliance with legal and organizational requirements.
• Attend and actively participate in department meetings, staff training, and peer reviews to support team cohesion and development.

7. Leadership and Role Modeling:

• Provide leadership and mentorship to billing staff, promoting professionalism, accuracy, and efficiency in billing practices.
• Demonstrate positive role modeling for clients and staff, fostering a supportive and productive work environment.

8. General Responsibilities:

• Maintain accurate and up-to-date documentation of billing and patient information in compliance with state and organizational requirements.
• Ensure timely submission of clinical updates in collaboration with clinical teams.
• Adhere to company attendance, punctuality, and dependability standards, including working 40 hours per week.

CENTER-WIDE ESSENTIAL DUTIES & RESPONSIBILITIES

• Maintain confidentiality of client information by adhering to Colorado state law, HIPAA regulations, and PRC's Standard Operating Policies and Procedures.
• Ensure compliance with all applicable federal, state, and local laws, professional practice acts, ethical guidelines, PRC policies, and contractual obligations.
• Actively support and promote PRC’s Mission, Vision, and Purpose by embodying and modeling the company’s values and culture.
• Complete all required training sessions and participate in additional training as requested or assigned by the supervisor.
• Demonstrate excellence in verbal and written communication, attention to detail, strong work ethic, effective scheduling, and proficient computer skills.

MISC. DUTIES AS ASSIGNED

This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. It is not intended to limit or in any way modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision. The use of a particular expression or illustration describing duties shall not be held to exclude other duties not mentioned that are of similar kind or level of difficulty.

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education or Formal Training and Experience:

• High School Degree or equivalent; Bachelor’s Degree Preferred.
• 2+ years of experience with healthcare collections and commercial insurances (BCBS, Humana, Aetna, etc).
• 2+ years of experience in various billing/front office roles.
• 2+ years of A/R experience within a medical billing environment.
• 3+ years of customer service experience.

Knowledge, Skill and Ability:

• Knowledge of ICD-10 and CPT Codes.
• Comprehensive knowledge of Revenue Cycle Management processes and payer-specific practices.
• Strong communication and problem-solving skills to effectively address billing issues with patients, staff, and payers.
• Ability to work collaboratively in an interdisciplinary team environment.
• Familiarity with state and federal regulations related to healthcare billing and compliance.
• Excellent verbal and written communication skills to a broad variety of stakeholders.
• Ability to lead in a supportive, professional manner.
• Ability to work well with other agencies and businesses in the community.
• Ability to maintain strict confidentiality, adhering to all HIPAA guidelines/regulations.
• Ability to listen, problem solve, resolve conflict, and be solution focused.
• Ability to meet due dates, time requirements, and commitments.
• Ability to communicate clearly and effectively with clients, staff, and the public.
• Ability to remain open minded and take direction.
• Ability to travel within the community.
• Ability to interact with people in a professional, friendly manner.
• Ability to work independently as well as cooperatively and constructively as part of an interdisciplinary team.
• Ability to think critically and independently.
• Ability to realize and activate potential in every interaction, every day.
• Ability to adapt to change in the workplace.
• Ability to use change as an opportunity for innovation and creativity.
• Ability to inspire and model collaborative teamwork.

WORKING ENVIRONMENT/PHYSICAL ACTIVITIES: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The primary work environment is done within the office environment or while working from home (as needed and approved by direct supervisor).

If you are looking for an opportunity to lead a dynamic billing team while ensuring accuracy and compliance in our processes, we encourage you to apply for the Billing Manager position!

Job Type: Full-time

Pay: $65,000.00 - $75,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Professional development assistance
• Relocation assistance
• Vision insurance

Schedule:

• Monday to Friday

Supplemental Pay:

• Bonus opportunities
• Performance bonus

Work Location: In person