Manager of Billing and Collections

Job Description

Job Description

Job Title : Manager of Billing and Collections

Reports to: Director of Reimbursement and Payer Operations

Summary

The Manager of Billing and Collections is responsible for the strategic leadership, operational oversight, and performance management of all accounts receivable functions, including billing, collections, denial management, transplant global billing, payer relations, payer escalations, and reimbursement optimization initiatives. This role ensures the timely and accurate resolution of outstanding accounts receivable while driving process improvements, regulatory compliance, and financial performance across the revenue cycle for over 1000 providers with increasing annual gross charges.

The manager serves as the primary escalation point for complex payer issues and reimbursement challenges, partnering with internal stakeholders and external payers to resolve systemic issues, reduce denials, improve cash flow, and maximize reimbursement. This position provides leadership to management and frontline teams while overseeing payer-focused projects, contract implementation support, and strategic initiatives designed to improve revenue cycle outcomes

Leadership & Operational Management

• Interact and partner with multiple internal departments to ensure timely and accurate billing of claims and collection of balances owed to the University of Illinois Physicians group.

• Provides strategic leadership and oversight for all Claims & Accounts Receivable operations, including billing, follow-up, denial management, cash acceleration, and collections.
• Directly manages Claims & AR supervisors, and team leads while fostering a culture of accountability, collaboration, and continuous improvement.
• Establishes departmental goals, performance standards, productivity metrics, and quality assurance measures.
• Monitors key performance indicators (KPIs) and develops action plans to improve AR performance, denial rates, aging, and reimbursement outcomes.
• Oversees supervisor development, coaching, mentoring, performance evaluations, and succession planning.
• Ensures compliance with organizational policies, payer requirements, industry regulations, and reimbursement guidelines.
• Oversees all billing activities, including professional billing, transplant global billing, government payers, commercial payers, and managed care plans.
• Manages denial prevention and denial management strategies to improve first-pass resolution and reduce avoidable write-offs.
• Ensures timely resolution of complex accounts, underpayments, reimbursement discrepancies, and aged receivables.
• Reviews and analyzes reimbursement trends, payment variances, contractual compliance, and payer performance.
• Identifies root causes of revenue leakage and develops corrective action plans to improve reimbursement outcomes.

Payer Relations & Escalations

• Serves as the primary operational liaison for payer escalations and complex reimbursement disputes.
• Leads payer meetings and business reviews to address recurring denial patterns, payment delays, system issues, and contractual concerns.
• Develops and maintains strong relationships with government, managed care, commercial, and specialty payers.
• Coordinates cross-functional efforts to resolve systemic payer issues impacting reimbursement and account resolution.
• Escalates unresolved payer concerns and negotiates solutions to improve payment accuracy and timeliness.
• Supports contract implementation, payer policy changes, reimbursement initiatives, and operational readiness activities.

Project Management & Process Improvement

• Leads payer-related projects, reimbursement initiatives, workflow redesigns, system enhancements, and revenue cycle optimization efforts.
• Collaborates with contracting, finance, compliance, patient access, HIM, coding, and clinical operations teams to improve revenue cycle performance.
• Utilizes data analytics to identify operational opportunities and drive process improvements.
• Develops and implements standard operating procedures, workflows, and best practices.
• Oversees system testing, payer implementation projects, and revenue cycle technology enhancements.
• Collaborates and partners with the Director of Reimbursement and Payer Operations on strategic process improvements and specialized projects.

Reporting & Financial Performance

• Analyzes and presents AR performance, denial trends, payer outcomes, cash collection metrics, and operational reports to executive leadership.
• Develops action plans to achieve organizational goals related to cash collections, AR aging, denial reduction, and reimbursement optimization.
• Monitors departmental resource allocation, and operational efficiencies.
• Provides recommendations for strategic initiatives based on financial and operational analysis.
• Compliance & Quality Assurance
• Maintains expertise in payer regulations, CMS guidelines, reimbursement methodologies, and industry best practices.
• Ensures compliance with federal, state, and payer-specific billing requirements.
• Participates in audits and implements corrective actions as necessary.
• Supports organizational compliance programs and risk mitigation efforts.
• Provides support to AR department as the team's "go to" person for training and questions.
• Provides support to staff with resolving complex accounts and with techniques to increase production, quality and collections.
• Reports trends to management and provides operational guidance and/or suggestions for resolution and prevention of errors.
• Analyzes and resolves complex insurance denials; responds to escalated patient and insurance inquiries.
• Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions.
• Assists management with running reports as needed.
• Research and obtain required documents to resolve misdirected payment issues.
• Files appeals and/or resubmit unresolved invoices to insurance carriers.
• Accurately and thoroughly documents the pertinent collection activity performed.
• Assists with special projects and other duties as assigned.

Knowledge & Abilities:

• Knowledge of collections, healthcare terminology and office procedures.
• Intermediate to Expert knowledge of CMS 1500 claims, CPT Codes, ICD-10 and HCPCS Codes.
• Goal-oriented – holds him/herself accountable to achieving shared and personal goals.
• Strong understanding of government payers, managed care payers, other commercial payers and Self-Pay processes and reimbursements.
• Masters and understands all job functions and aspects within the revenue cycle department.
• Attention to detail with the ability to identify/resolve problems and document the outcomes and next steps
• Maintains a high level of confidentiality.
• Intermediate level knowledge of Microsoft Office applications: Word and Excel.

Skills:

• Communication: Strong concise, clear written and verbal communication skills. Manages difficult patient and other customer situations.

• Organization: ability to multi-task and work independently.
• Analytical: Strong analytical skills; ability to evaluate claims, payer data, identify denial trends and root causes, develop actionable reporting to improve reimbursement performance and reduce revenue leakage
• Interpersonal: motivating team, setting clear performance expectations, and facilitating training on new claim systems and collection guidelines . cross-functional collaboration, conflict resolution, client relations, and team leadership

• Establish and maintain long-term interdepartmental relationships, building trust and respect by consistently meeting and exceeding expectations.
• Establish and maintain effective working relationships with employees, patients and external vendors.

Education/ Experience:

Associate's or Bachelor's degree in accounting, business administration, healthcare administration or related field preferred or 5-7 years of collection experience with required knowledge of insurance billing, collection methods and procedures of which 2 years were in a AR, denial management and transplant global billing managing capacity. 3-4 years of billing or claims processing experience.

Must have demonstrated strong managerial experience. High level of customer service skills, strong communication, and negotiation skills are needed to effectively communicate and resolve disputes. Proven ability to work well with others in a diverse environment is a must.

Practice Management Software : Experience with Epic Resolute PB experience preferred, Availity experience a plus.