Job Summary

Position Title: Billing Manager

 

Position Summary: The Billing Manager provides strategic and operational leadership for the organization’s billing and revenue cycle functions, with accountability for maximizing revenue integrity, optimizing cash flow, strengthening financial controls, and ensuring regulatory and payer compliance. This role oversees end-to-end billing operations, including charge capture, claims management, payment posting, reconciliation, denials and claim holds, and revenue cycle performance. The Billing Manager leads a high-performing billing team, establishes operational standards and controls, and uses data, technology, and automation to drive efficiency and financial performance. The position serves as a key business partner to Finance, Operations, Credentialing, IT, and clinical leadership and is responsible for advancing revenue cycle capabilities through process optimization, system enhancements, automation, and continuous improvement.

Responsibilities

Billing Operations Management

• Direct and oversee all billing department activities, including charge entry, claim submission, payment posting, and account reconciliation.
• Supervise and support billing staff to ensure productivity, accuracy, and accountability.
• Ensure all charges are entered accurately and submitted within established timelines.
• Monitor claim status and proactively address claim holds, denials, and rejections.
• Develop and maintain standard operating procedures for billing workflows.
• Ensure compliance with payer requirements, contractual obligations, and regulatory standards.

Charge Entry and Reconciliation

• Provide oversight of charge capture processes to ensure complete, accurate, and timely billing for services rendered.
• Establish controls to reconcile services rendered, charges entered, and claims submitted.
• Direct investigation and resolution of charge discrepancies and workflow breakdowns.
• Implement routine audits and quality assurance measures to maintain billing accuracy.

Payment Posting and Financial Reconciliation

• Oversee payment posting processes for insurance and patient payments.
• Ensure accurate allocation of payments, adjustments, and write-offs.
• Reconcile posted payments to bank deposits and financial records.
• Investigate and resolve payment variances, discrepancies, and unapplied funds.
• Maintain documented controls for reconciliation processes.

Claims Management

• Monitor billing submissions and ensure claims are submitted within three (3) business days of service completion.
• Audit claims held within the billing system and ensure no claims exceed payer timely filing limits.
• Identify the root causes of held claims and implement corrective actions.
• Monitor clearinghouse and payer responses to ensure timely resolution of claim issues.

Credentialing Hold Management

• Collaborate with the Credentialing Team to monitor and reconcile claims held due to provider credentialing issues.
• Establish tracking and reporting processes for credentialing-related claims holds.
• Ensure timely follow-up and resolution to prevent revenue loss.
• Facilitate regular cross-department communication regarding credentialing status and financial impact.

System Optimization and Automation

• Serve as a lead for successful transition from PARCS AR module to eCW AR module.
• Serve as the departmental lead for eClinicalWorks billing system optimization.Serve as the departmental lead for eClinicalWorks billing system optimization.
• Maximize utilization of eClinicalWorks automation tools to eliminate manual workflows whenever feasible.
• Identify opportunities to improve workflow efficiency, reduce errors, and enhance productivity.
• Partner with leadership and IT resources to implement system enhancements and reporting solutions.
• Ensure system configurations support operational efficiency and revenue cycle best practices.

Process Improvement and Internal Controls

• Evaluate existing workflows and identify opportunities for process improvement.
• Develop and implement checks and balances across all billing functions.
• Establish monitoring mechanisms to ensure workflows are followed consistently.
• Conduct routine audits to verify process effectiveness and compliance.
• Drive continuous improvement initiatives focused on revenue enhancement and operational excellence.

Staff Leadership and Performance Management

• Supervise, train, mentor, and develop billing team members.
• Conduct regular performance evaluations and coaching sessions.
• Monitor employee productivity, quality, and KPI achievement.
• Foster a culture of accountability, collaboration, and continuous improvement.
• Assist with hiring, onboarding, and workforce planning as needed.

Key Performance Indicators (KPIs)

The Billing Manager will be accountable for measurable performance across the following areas:

Revenue Cycle KPIs

• 95%+ of claims submitted within 3 business days of date of service or charge completion
• Consistent improvement in clean claim and first-pass acceptance rates.
• Reduction in claim rejection, denial, and hold volume.
• Zero claims exceeding payer timely filing limits due to internal processing delays
• 100% review and resolution of claims on hold within established departmental guidelines
• Monthly reconciliation of all charge entry activity to ensure charge capture accuracy
• Monthly reconciliation of payment posting to bank deposits with documented resolution of variances

Operational KPIs

• Increased utilization of eClinicalWorks automation and system functionality.
• Measurable reduction in manual billing processes and unnecessary administrative effort.
• Improved clean claim rate and first-pass acceptance rate.
• Reduced claim hold volume and aging.
• Reduced payment posting errors and reconciliation discrepancies.
• Timely resolution of credentialing-related billing holds.

Staff Performance KPIs

• Achievement of individual productivity standards for billing staff.
• Accuracy rates meet departmental quality standards.
• Completion of required audits, training, and process reviews.
• Employee engagement, accountability, and performance improvement goals.

Qualifications

Education

• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field preferred., Business Administration, Finance, or related field preferred.

Experience

• 5+ years of medical billing and revenue cycle management experience.
• 2+ years of supervisory or management experience preferred.
• Extensive knowledge of health insurance billing, payment posting, claims management, and revenue cycle operations.
• Experience with eClinicalWorks (eCW) is strongly preferred.

Knowledge, Skills, and Abilities

• Strong understanding of healthcare revenue cycle operations, payer requirements, billing regulations, and financial controls.
• Advanced knowledge of claims management, payment reconciliation, charge capture, denials, and revenue integrity.
• Strong analytical and problem-solving skills.
• Experience implementing process improvements and system optimization initiatives.
• Proficiency with billing software, reporting tools, and Microsoft Office applications.
• Excellent leadership, communication, and organizational skills.
• Ability to influence and collaborate effectively across Finance, Operations, Credentialing, IT, clinical leadership, and external partners.
• Ability to manage competing priorities and lead effectively in a complex, high-volume environment.

 

Success Measures for the Role

The Billing Manager is expected to operate as a strategic revenue cycle and operational manager. Success in this role will be demonstrated through measurable improvements in revenue integrity, cash flow, billing efficiency, automation, financial controls, regulatory compliance, and team performance.

 

The successful leader will build a scalable and highly controlled billing operation that consistently delivers timely and accurate claims, effective reconciliation, reduced revenue leakage, optimized use of eClinicalWorks, minimal avoidable claim holds and denials, and a high-performing team aligned with the organization’s broader financial and operational objectives.