Billing Revenue Cycle Manager

OVERVIEW OF POSITION:

The Billing & Revenue Cycle Manager will lead and develop the Billing Specialist team and oversee the billing cycle, from intake and eligibility through payment posting, denials, and audits. The Billing & Revenue Cycle Manager shows initiative to step in, assess the billing process, and start improving results.

ESSENTIAL FUNCTIONS:

• Lead, train, and set work priorities for the Billing Specialist team, including productivity and accuracy standards.
• Own front-end accuracy: eligibility and benefits verification in Brightree, communicating coverage, deductibles, and coinsurance to Customer Service and leadership.
• Make sure claims are supported before they go out: correct HCPCS codes and modifiers, diagnosis support, span dates, and documentation such as SWOs, proof of delivery, and CMNs where required.
• Manage ERA/EOB payment posting to keep secondary billing and patient statements flowing.
• Drive denial management and appeals, identifying root causes and fixing them upstream rather than just reworking claims.
• Work directly with payers to resolve underpayments, quantity limits, diagnosis issues, and filing errors.
• Determine prior authorization requirements and build the processes to meet them.
• Partner with our Contracting & Credentialing team on new payer contracts, fee schedules, and EFT/ERA enrollment with Brightree and the clearinghouse.
• Lead responses to Medicare and commercial payer audits (TPE, RAC, UPIC, CERT, and payer post-payment reviews).
• Report on key revenue cycle metrics, including A/R aging, DSO, denial rate, clean claim rate, and cash collections, to the Director of Operations.