Billing/Coding Manager

Job Title: Billing/Coding ManagerDepartment: Revenue Cycle ManagementReports To: Director of FinanceLocation: Integrated HealthJob Type: Full-TimePosition Summary:The Billing/Coding Manager oversees billing, coding, provider enrollment, credentialing, and insurance verification operations for a multispecialty outpatient facility, including Behavioral Health, Chiropractic, Physical Therapy, Family Medicine, Nutrition, and Massage Therapy. This role ensures regulatory compliance, accurate coding, timely claim submission, effective denial management, provider enrollment and credentialing, and accurate insurance eligibility verification for both new and established patients. The ideal candidate demonstrates strong multi-payer billing knowledge, leadership skills, and the ability to collaborate with Multispecialty Clinic Coordinators and clinical providers to support documentation accuracy, reimbursement, and overall revenue cycle performance.Key Responsibilities:Leadership & Oversight:Supervise billing and coding staff with a focus on accuracy, compliance, and professional development.Provide training and onboarding for new billing department team members to ensure they are equipped with the knowledge and tools to succeed.Develop and maintain insurance-compliant billing and coding protocols for all payers.Serve as the subject matter expert on payer rules and requirements across all clinic specialties.Serve as a liaison to external billing consultants or vendors when necessary to ensure efficient billing operations and issue resolution.Insurance Billing & Coding (Multispecialty Focus):Ensure proper CPT, ICD-10, and HCPCS coding for all clinical services across Behavioral Health, Chiropractic, Physical Therapy, Family Medicine, Nutrition, and Massage Therapy.Manage multi-payer claim submission, payment reconciliation, denial management, and appeals.Stay current on payer-specific guidelines and communicate updates to billing and clinical staff.Provider Enrollment, Credentialing & Insurance VerificationManage all aspects of provider enrollment and credentialing with commercial insurance plans, Medicare, Medicaid, and other third-party payers.Monitor credentialing and enrollment statuses to ensure providers remain active and enrolled with all contracted payers.Coordinate provider revalidations, recredentialing, and enrollment updates as required.Verify insurance benefits and eligibility for incoming new patients and perform periodic eligibility reviews for established patients in accordance with organizational procedures.Maintain accurate credentialing records and ensure timely completion of all required documentation.Collaborate with clinic leadership to resolve credentialing or eligibility issues that may affect patient access or reimbursement.Compliance & Quality Control:Ensure all billing and coding practices comply with payer policies, commercial guidelines, and HIPAA.Lead internal audits and implement corrective actions as needed.Support internal and external audits and maintain audit-readiness documentation.Cross-Functional Collaboration:Work closely with Multispecialty Clinic Coordinators to ensure provider documentation supports proper coding and reimbursement.Collaborate with providers and clinical teams to address documentation deficiencies and support compliance training.Participate in multidisciplinary meetings to address workflow or documentation challenges affecting claims.Revenue Integrity & Reporting:Monitor and report on KPIs such as clean claim rate, A/R aging, denial trends, and payer performance.Proactively recommend and implement process improvements for efficiency and revenue capture.Maintain current and accessible documentation of workflows, coding policies, and payer requirements.Qualifications:Required:3–5 years of billing and coding experience in a multispecialty or outpatient clinical setting.3+ years of experience managing medical billing and insurance teams (multi-location preferred).Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential.Proficiency with Athena and Jane EHR systems.Experience with provider enrollment, credentialing, and insurance eligibility verification.Preferred:Experience working with integrated care or outpatient multispecialty clinics.Familiarity with commercial payer rules and prior authorization workflows.Understanding of payer-specific requirements for Chiropractic and Physical Therapy billing.Extensive knowledge of revenue cycle management, insurance verification, coding, denial management, and collections.Proven ability to interpret and act on financial reports, insurance aging, and performance KPIs.Familiarity with Medicare and major commercial insurance payers; knowledge of cash-based and insurance-based hybrid service models.Experience managing provider enrollment and credentialing for multiple specialties and payer types.Strong leadership, problem solving, and team development skills.Benefits:Competitive salaryHealth, dental, and vision insurancePaid time off (PTO) and holidaysContinuing education and training opportunitiesA supportive and collaborative team environmentHours are 8A-5P. #J-18808-Ljbffr Integrated Health of Southern Illinois