Billing Manager

Summary Responsible for leading and optimizing billing operations to ensure standardized workflows, regulatory compliance, and operational continuity. This role collaborates with Patient Access, Coding, Clinical Documentation Improvement (CDI), Revenue Integrity, Information Technology (IT), and Finance to implement billing strategies that improve clean claim rates, reduce denials, and ensure compliant reimbursement. The position supports process standardization, performance monitoring, and operational improvement across billing functions. Principal Job Functions *Commits to the mission, vision, beliefs and consistently demonstrates our core values. *Develops and implements standardized billing workflows, policies, and procedures across service lines. *Leads initiatives to reduce variation in billing practices and improve system-wide efficiency. *Establishes and monitors performance metrics, including clean claim rate, Discharged Not Final Billed (DNFB), accounts receivable (AR) days, and denial rates. Ensures effective utilization and optimization of billing systems and electronic health record platforms across the system. *Drives process improvement using data analysis, root cause identification, and performance monitoring. *Ensures adherence to all federal, state, and payer-specific billing regulations (CMS, Medicaid, commercial payers). *Maintains compliance with HIPAA, reimbursement methodologies (IPPS/OPPS), NCCI edits, and payer contracts. *Leads internal and external audit readiness, including documentation standards and corrective action plans. Monitor regulatory updates and implement system-wide changes to maintain compliance. *Partners with Compliance and Revenue Integrity to mitigate risk and prevent billing errors. *Designs and implements cross-training programs to ensure staff competency across multiple billing functions and service lines. Maintains staffing models to support operational continuity, workload fluctuations, and coverage needs. *Oversees timely and accurate claim submission for all patient services (inpatient, outpatient, professional, and ancillary). *Monitors claim edits, rejections, and denials; lead corrective action and prevention strategies. Analyzes trends in billing errors, late charges, and payer behaviors to improve outcomes. Manages resolution of complex and high-dollar billing accounts. *Prepares and presents performance reports and dashboards to leadership. *Leads, coaches, and develops staff, including hiring, training, mentoring, and evaluating teams across multiple sites or centralized functions. *Establishes a culture of accountability, collaboration, and continuous improvement. *Collaborates with internal departments to prevent downstream billing issues and improve revenue cycle outcomes. *Serves as a key stakeholder in system-wide revenue cycle initiatives and projects. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise. Participates in and/or leads meetings, committees, strategic planning and lean projects as assigned. *Oversees the departmental budgetary procedure to ensure proper operational and capital planning, appropriate and efficient use of resources, and consistent compliance to budgetary and fiscal controls. *Responsible for hiring, training, supervising, coaching, mentoring, retaining and evaluating of staff. Performs other related projects and duties as assigned. Required Knowledge, Skills and Abilities Knowledge of organizational, human resource, management, and leadership principles and practices. Knowledge of healthcare billing processes, reimbursement methodologies, payer requirements, and revenue cycle operations. Knowledge of regulatory standards, including Centers for Medicare & Medicaid Services (CMS) and Health Insurance Portability and Accountability Act (HIPAA). Knowledge of billing systems, claims processing workflows, and financial, budgetary, and performance improvement practices. Knowledge of computer hardware equipment and software applications relevant to work functions. Knowledge of management and leadership principles and practices. Skill in analyzing billing data, monitoring performance metrics, and identifying process improvement opportunities. Skill in managing billing operations, leading teams, coaching employees, and resolving conflict. Ability to lead and manage operations in a complex healthcare environment and implement standardized processes across multiple functions. Ability to communicate effectively both verbally and in writing and perform crucial conversations with desired outcomes. Ability to establish and maintain effective working relationships across all levels of the organization. Ability to problem solve, prioritize work, and exercise independent judgment in a dynamic environment. Ability to make operational and management decisions in response to changing conditions. Ability to maintain confidentiality, handle sensitive information, and maintain regular and punctual attendance. Education and Experience Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required. Minimum 5 years of healthcare billing/revenue cycle experience. Minimum 2 years of leadership experience, preferably in a system or multi-site environment. Demonstrated experience with process standardization and system implementations. Other Credentials / Certifications CRCR, CSPR, EHRC, CHFP, CRCP, CRCE or other relevant revenue cycle certification preferred. Physical Requirements (Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.) (DOT) Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. #J-18808-Ljbffr