CAH-Billing Manager

Billing ManagerThe Billing Manager provides leadership and oversight of the hospital's insurance accounts receivable operations, with a primary focus on timely reimbursement, denial prevention and resolution, payer follow-up, and accounts receivable performance. This position is responsible for managing complex insurance claims, coordinating with commercial, Medicare, Medicaid, and managed care payers, and ensuring accurate reimbursement through proactive follow-up and escalation. The position monitors payer trends, denial patterns, regulatory changes, and reimbursement policies to ensure compliance while implementing process improvements that reduce denials, improve collections, and decrease accounts receivable days outstanding. Through effective use of the Revenue Cycle System, the Billing Manager evaluates workflow efficiencies, develops staff, and ensures operational excellence while achieving industry benchmark performance metrics.Essential Responsibilities:Provide leadership and oversight of insurance accounts receivable operations.Manage and monitor insurance A/R work queues to ensure timely claim resolution and reimbursement.Lead denial management efforts, including identifying trends, root cause analysis, appeals, and corrective action planning.Work directly with commercial, Medicare, Medicaid, and managed care payer representatives to resolve complex claim and payment issues.Escalate unresolved payer issues through provider representatives and payer liaison channels when necessary.Monitor payer reimbursement accuracy and identify underpayments or contract compliance concerns.Ensure timely billing, follow-up, and payment of hospital claims while maintaining compliance with federal, state, and payer regulations.Monitor key revenue cycle performance indicators including A/R Days, Aging, Denial Rate, Clean Claim Rate, First Pass Resolution, and Cash Collections.Analyze payer trends and develop strategies to reduce denials and improve reimbursement performance.Identify workflow improvements and automation opportunities within the Revenue Cycle System to increase operational efficiency.Develop departmental policies and procedures that support best practices in insurance billing and collections.Supervise, mentor, and develop billing staff while establishing productivity and quality expectations.Prepare and present revenue cycle performance reports to executive leadership.Maintain knowledge of payer policies, reimbursement methodologies, regulatory requirements, and industry best practices.Reports To Director of Revenue CycleEducation Required High School Diploma or equivalent Preferred Bachelor's degree in Business, Healthcare Administration, Finance, or related field.Training & Experience Required Minimum of five (5) years of progressive hospital insurance billing, accounts receivable, or revenue cycle experience. Demonstrated experience in insurance follow-up, denial management, and payer reimbursement. Working knowledge of Medicare, Medicaid, commercial insurance, and managed care billing requirements.Preferred Three (3) years of supervisory or management experience in a healthcare revenue cycle environment.

Experience with hospital billing systems, EDI processes, and revenue cycle analytics. Knowledge of revenue cycle KPIs, payer contract reimbursement methodologies, and regulatory compliance.