Lead Revenue, Drive Impact: Billing Manager & Credentialing Administrator

SLEEPQUEST INC•San Carlos, CA

2d•$75,000 - $90,000•Remote

About The Position

We’re seeking a dynamic and results-driven Billing Manager & Credentialing Administrator to lead our medical billing team and elevate financial performance. This is a high-impact leadership role responsible for optimizing billing workflows, strengthening payer relationships, and ensuring compliance across all aspects of the revenue cycle. If you’re someone who thrives on improving processes, leading teams, and driving measurable results, this role is for you.

Requirements

Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred (or equivalent experience)
5–8+ years of medical billing or revenue cycle experience
2–4+ years of leadership experience
Strong knowledge of billing operations, AR management, and insurance reimbursement
High attention to detail and accuracy
Excellent communication and leadership abilities

Nice To Haves

Experience with credentialing and payer contract management strongly preferred
Experience with Brightree or similar DME/healthcare billing platforms strongly preferred
Strong analytical, organizational, and problem-solving skills

Responsibilities

Lead and manage Billing Specialist and Patient Account Specialist teams, including billing, denial management, collections, reimbursement, and eligibility verification
Ensure timely and accurate billing, invoicing, and claim submission
Oversee adherence to billing policies, procedures, and payer guidelines
Identify operational issues (EDI errors, payer changes, system issues) and implement corrective actions
Ensure claims are reviewed and confirmed within two business days of date of service (DOS)
Provide coverage for team members absent more than four business days
Monitor and manage all AR activity to ensure timely collections and strong cash flow
Maintain and drive performance benchmarks: Improve collections over 90+ days by at least 30% month-over-month
Limit 120+ day AR to no more than 15% of total receivables
Track insurance and patient balances from DOS and account creation
Analyze monthly AR aging reports to identify trends and improvement opportunities
Ensure complete and accurate documentation (prescriptions, clinical records, delivery tickets)
Verify claims meet payer requirements (ICD-10, HCPCS, CPT) prior to submission
Resolve issues such as missing authorizations, documentation gaps, and inventory discrepancies
Oversee third-party claim follow-up vendors to ensure adherence to SOPs
Review escalated claims and implement resolutions
Ensure revenue cycle worklists are completed within established timelines
Ensure Patient Accounts team meets established patient collection goals
Oversee third-party billing customer service vendors (e.g., Brightree Live Agent Services) to ensure quality and compliance
Monitor and resolve system alerts, work queues, and hold/stop reports
Address issues such as missing pricing, manual holds, and billing system flags
Ensure Compliance and New Insurance teams meet required timelines
Complete monthly billing pre-closing processes within established deadlines
Support Patient Relations in addressing insurance-related inquiries by providing billing expertise
Partner with the Qualification Team to ensure accurate insurance verification for new patient referrals
Serve as a subject matter expert on billing, insurance criteria, and reimbursement processes
Mentor and train staff to improve collection performance and efficiency
Manage credentialing for all new and existing payer contracts
Maintain contract files, payer relationships, and centralized database
Monitor and evaluate fee schedules to optimize reimbursement
Track contracted plans, NPIs, and insurance portal access
Coordinate updates with payers (locations, provider changes, etc.)
Conduct quarterly reviews of payer medical policies (e.g., OSA trends)
Monitor HCPCS and CPT updates and assess operational impact
Support contract negotiations and implementations
Review and approve Letters of Agreement for Workers’ Compensation referrals