Billing Operations Manager

Role Overview

• Drive Strong Billing Operations Team Performance
• Lead a team of revenue cycle professionals across billing, collections, and denials management, driving high billing operations performance
• Manage a team of onshore and offshore specialists across billing, payment posting, AR, and denials with clear ownership and accountability.
• Build SOPs, documentation, and scalable processes to ensure consistent and high-quality execution.
• Foster a culture of operational excellence and continuous improvement.
• Own AR performance and KPI management, including DSO, first-pass acceptance rate, denial rate, etc.
• Ensure Clean Claims & Prevent Denials
• Own processes that ensure accurate charge capture, eligibility, and coding before claims are submitted.
• Build preventive workflows to reduce first-pass rejections
• Partner with clinical, intake, credentialing, and coding teams to address upstream issues that drive repeat denials.
• Lead Claims Submission, Payment Posting & AR Management
• Oversee timely claim submission, remit posting, and structured AR follow-up workflows.
• Maintain consistent follow-up cadence by age bucket, payer, and denial category.
• Ensure all claims are processed, followed up on, and escalated within defined SLAs.
• Drive Denial Resolution & Recovery
• Lead a structured denial management program with root-cause categorization and recovery targets.
• Create SOPs for addressing common denial categories (coverage, coding, eligibility, prior auth, modifier issues, medical necessity, etc.).
• Oversee appeals, corrected claims, and secondary billing processes.
• Deliver a Patient-Friendly Billing Experience
• Build clear processes and service standards to ensure patient billing questions are answered accurately and promptly
• Create feedback loops from patient inquiries to identify recurring pain points and implement improvements across billing workflows
• Maintain Compliance & Strengthen Billing Operating Infrastructure
• Ensure compliance with payer policies, telehealth billing requirements, and documentation standards.
• Stay current on industry policies and billing best practices.
• Partner in the management of billing systems and vendors, and ensure swift resolution of any technical issues impacting billing

Requirements

• Bachelor's degree required; Master's degree in Healthcare Administration, Business, or related field preferred
• 5+ years of progressive experience in healthcare revenue cycle management
• 3+ years of leadership experience in a healthcare setting
• Experience with telehealth billing and reimbursement
• Demonstrated success in improving revenue cycle metrics (e.g., clean claim rates, AR days, denial rates)
• Strong understanding of healthcare reimbursement models, coding, and compliance requirements
• Experience with revenue cycle management systems and healthcare technology platforms
• Excellent analytical skills with the ability to translate data into actionable insights
• Exceptional communication and leadership abilities
• Experience utilizing modernized billing and EHR platforms such as Candid, Adonis, and Elation, highly preferred OR proven ability to learn new systems quickly

Tech Stack

• Swift

Benefits

• $115-$130K with opportunities for advancement
• Professional development and employee learning programs
• Unlimited PTO & 11 company holidays
• Medical, dental, and vision benefits
• Health Savings Account (HSA) & Flexible Spending Account (FSA) options
• Long
• and short-term disability coverage
• Annual employee wellness stipend
• 401(k) plan
• Parental leave & family planning support benefits
• Company-issued laptop
• Annual work-from-home stipend
• Commuter benefits (if applicable)