Billing Manager

Billing Manager

Requirements

• Bachelor’s degree in Business Administration, Health Administration, or a related field (or equivalent work experience)
• Minimum of 5 years of experience in billing, coding, or healthcare operations, with at least 2 years in a supervisory or management role
• In-depth knowledge of prior-authorization processes and insurance billing procedures
• Experience with laboratory billing systems, healthcare insurance claim submission, and payment processes
• Strong leadership and team management skills with the ability to motivate and develop employees
• Excellent communication skills, both verbal and written, with a focus on customer service and collaboration
• Strong analytical and problem-solving skills, with the ability to identify issues and create actionable solutions
• Proficiency in Microsoft Office Suite and claims management software
• Familiarity with regulatory requirements related to healthcare billing, HIPAA compliance, and insurance payer policies
• Understanding of insurance company processes, including prior-authorization and claims review processes

Responsibilities

• Lead, coach, and develop a team of prior-authorization specialists, ensuring high levels of performance and motivation
• Ensure that all claims are prepared and ready for submission to insurance carriers, including reviewing for accuracy and completeness before sending
• Work with the Associate Director of Billing to identify opportunities to streamline and improve pre-claims operations
• Oversee the initial review of policyholder inquiries, ensuring accuracy before claim submission
• Work closely with third-party vendors and internal departments to ensure smooth handoffs and effective resolution of issues
• Act as the point of contact for resolving issues related to prior-authorizations, billing discrepancies, or denied prior-authorizations
• Ensure that all prior-authorization and billing practices comply with federal, state, and local regulations, as well as insurance company guidelines and laboratory policies
• Develop training programs and materials for new hires and existing team members
• Provide regular reports to leadership regarding the status of prior-authorization requests, billing accuracy, claim rejections, and other relevant metrics

Preferred Qualifications

• Prior experience with Xifin and careviso is highly desirable
• Certification in medical billing or coding (e.g., Certified Professional Coder (CPC), Certified Coding Specialist (CCS))