Position: The Director of Billing Job Overview:The Director of Billing provides strategic leadership and operational oversight for Coral's billing, reimbursement, and revenue cycle performance across managed service clients. This role serves as the primary subject matter expert (SME) for infusion billing, coding, claims, denials, and payor reimbursement - aligning billing operations, payor strategy, and financial performance to drive scalable, high-performance outcomes. The Director partners cross-functionally with internal service lines and external clients to standardize billing workflows, optimize reimbursement, and enable consistent, data-driven financial performance across Coral's platform.
Your key responsibilities will include: Strategic Leadership - Drive development and deployment of standardized billing and reimbursement playbooks across all clients.
- Partner with Coral's technology team to define requirements for billing enablement within Coral's platform (e.g., denial tracking, reimbursement analytics, claims workflow visibility).
- Provide strategic direction for billing and reimbursement operations across multiple client organizations.
- Serve as the infusion billing and reimbursement subject matter expert for the RCM organization.
- Develop standardized best practices for infusion billing, coding, and revenue cycle processes.
- Serves as a mentor to high potential associates.
Client Relationship Management - Act as a senior-level advisor and operational partner for clients on billing and reimbursement matters, serving as the main point of escalation for client concerns.
- Assist with monthly business reviews with client leadership focused on financial performance, reimbursement trends, and optimization roadmap.
- Provide recommendations and influence client decisions related to payor contracting alignment, drug acquisition/reimbursement strategy, and overall program financial efficiency.
- Organize deep research into client performance, analyzing trends and recommending improvements.
Program Financial Optimization - Partner with internal stakeholders to align drug acquisition strategy with reimbursement and GPO performance.
- Evaluate billing readiness and downstream claims workflows to identify reimbursement risk before submission.
- Identify opportunities to improve reimbursement for infusion medications, administration services, and related supplies.
- Support optimization of payor contracting considerations and infusion billing delivery models.
Revenue Cycle Collaboration - Provide subject matter expertise on medical vs. pharmacy benefit billing pathways, including cross-walk considerations.
- Support development of payor-specific billing and documentation strategies.
- Partner closely with the Director of Intake and RCM leadership to ensure verified, authorized referrals convert cleanly into accurate claims.
- Provide guidance on infusion-specific billing requirements including but not limited to: drug billing using HCPCS/J-codes, National Drug Codes (NDC), infusion administration CPT codes, and drug wastage and modifier usage.
- Assist in resolving complex payor reimbursement issues and establish escalation frameworks for systemic billing and denial trends.
Operational Performance & Analytics - Monitor key revenue cycle metrics across client accounts, including but not limited to: drug reimbursement performance, denial trends, days in A/R, and revenue per infusion visit.
- Develop operational improvement plans based on performance data.
- Partner with analytics teams to ensure data integrity, reporting consistency, and actionable insights.
- Drive adoption of real-time performance monitoring tools (e.g., denial tracking, reimbursement dashboards).
Regulatory Compliance - Ensure compliance with regulatory standards including payor billing requirements, CMS guidelines including billing and documentation requirements, OIG guidance related to infusion reimbursement, and industry best practices.
- Maintain awareness of evolving reimbursement policies impacting infusion therapy.
- Support overall departmental compliance and audit readiness for billing and claims documentation.
Team Leadership & Development - Provide guidance and support to internal billing managers and operational teams.
- Assist in developing training materials, competency frameworks, and operational protocols related to infusion billing services.
- Ensure ongoing team education, training, and competency validation occur.
- Mentor staff on billing workflows and reimbursement considerations.
Process Improvement - Identify operational inefficiencies in billing and claims processes and implement standardized solutions across client accounts, ensuring scalable operating models.
- Drive continuous improvement and workflow optimization through automation, technology adoption, and workflow redesign.
Qualifications: To excel in this role, you should possess the following qualifications:
- High school diploma or equivalent
- 5+ years of healthcare experience with significant experience in infusion services billing and reimbursement services for both pharmacy and medical benefits
- 3+ years of leadership or manager-level experience
- Strong understanding of infusion reimbursement, payor policies, and revenue cycle workflows
- Experience working with outpatient infusion centers, specialty pharmacy, oncology infusion, or hospital-based infusion services
- Demonstrated experience managing multi-site or multi-client environments
- Deep knowledge of infusion billing operations and reimbursement models
- Strong strategic thinking and operational leadership abilities
- Excellent client relationship and executive communication skills
- Ability to analyze financial and claims performance metrics
- Strong problem-solving and process improvement skills
- Ability to manage multiple client engagements simultaneously
Job Benefits: Health, Dental, Vision, Life, 401k, Paid Time Off.
Location: Remote with limited travel to client locations, internal business meetings, and other locations as needed.
