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BILLING OPERATIONS MANAGER SUMMARY:The Billing Operations Manager oversees all billing-related functions within the organization, ensuring efficient, accurate, and compliant financial workflows. Reporting to executive leadership, this individual leads a team of billing professionals, drives process improvements, and ensures the timely processing of claims and account receivables. This position plays a key role in optimizing revenue performance, upholding regulatory standards, and fostering a high-performing team culture. RESPONSIBILITIES:
Supervise and support billing staff, including performance monitoring, training, conflict resolution, and workflow management.
Ensure accurate and timely claims processing, denial resolution, and compliance with payer guidelines and internal policies.
Monitor cash flow impacts and make strategic decisions to maintain financial continuity.
Develop and maintain standard operating procedures (SOPs) and ensure staff adherence.
Coordinate staff training programs and maintain current knowledge materials for billing operations.
Identify and implement process improvements that increase efficiency, accuracy, or revenue capture.
Oversee regulatory compliance across government and commercial payers; stay current with policy changes.
Collaborate with software vendors and payers to troubleshoot and resolve system-related issues.
Review aging reports, identify underpayment trends, and initiate corrective actions.
Participate in hiring and staffing decisions; provide feedback on performance and attendance.
Track departmental KPIs and generate reports to support strategic planning.
Ensure confidentiality & adherence to data security and privacy standards (e.g., HIPAA).
Maintain a professional and supportive working environment across departments.
QUALIFICATIONS:
Bachelor’s degree in business, healthcare administration, or related field preferred; relevant experience may substitute for formal education.
Prior experience in billing operations, revenue cycle management, or medical claims processing required.
Leadership experience in a healthcare or service-based setting strongly preferred.
Knowledge of commercial and government payer billing guidelines, including Medicare and Medicaid.
Strong understanding of claim systems, A/R processes, and denial management.
Certification in Medical Billing or Revenue Cycle (preferred but not required).
Excellent organizational, analytical, and communication skills.
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