Billing Manager

Borinquen Health Care Center•Miami, FL

About The Position

The Billing Manager is responsible for leading, planning, and directing all billing and revenue cycle operations for all Borinquen Health Care Center, Inc. (BHCC) locations. This role ensures accurate and timely billing, compliance with federal and state regulations, and efficient coordination across departments that support the organization’s financial performance. The Billing Manager designs, implements, and enforces billing policies and procedures while streamlining workflows to support Borinquen’s mission of providing quality, accessible care. This position requires a strong leader who can prioritize, plan, and maintain high operational performance in a dynamic environment.

Requirements

Bachelor’s degree Business Administration, Health Administration, or related field preferred.
Minimum 5–10 years of medical billing experience, preferably in an FQHC or multi-site outpatient setting.
Certified Coder AHIMA or AAPC
Minimum of 3–5 years of supervisory/management experience.
Experience with Medicaid, Medicare, commercial insurance, managed care plans, and grant-funded program billing.
Experience with EHR and practice management systems (e.g., eClinicalWorks, NextGen, Athena, Epic).
Must handle information with a high level of confidentiality.
Strong interpersonal skills and the ability to work effectively with diverse populations.
Excellent written and verbal communication skills.

Nice To Haves

Bilingual (English/Spanish or English/Creole) preferred.

Responsibilities

Oversee, manage and audit all daily operations of the BHCC billing department, including charge entry, claim submission, payment posting, accounts receivable, collections, and patient statements.
Ensure all billing practices comply with State and Federal regulations, FQHC regulations, including Medicaid PPS, Medicare FQHC billing rules, Medicaid/Medicare Advantage requirements, UDS reporting alignment, and HRSA program expectations.
Maintain and update BHCC’s Charge Master/Fee Schedule and Sliding Fee Scale in accordance with organizational policy and regulatory requirements such as CMS (Centers for Medicare and Medicaid), and compliance with HRSA requirements
Ensure appropriate billing application for Charity Care and Sliding Fee Discount Program guidelines in the billing system.
Oversee billing for all BHCC programs, including Primary Care, Behavioral Health, Ryan White, SFAN, Test & Treat, Ending the HIV Epidemic, Dental, Pediatrics, OB/GYN, Specialty, Wrap Around, and other grant-funded programs.
Review billing edits for encounters and work with front end billing staff to make appropriate corrections before claim submission.
Monitor payer-specific billing requirements and implement changes promptly.
Lead denial management efforts, identify trends, and work across departments to implement corrective actions.
Develop, implement, and maintain BHCC billing policies, procedures, that promote efficiency, compliance, and consistency.
Conduct regular audits of coding, documentation, charge capture, and payment posting to ensure compliance and accuracy.
Work collaboratively with providers and clinical teams to resolve documentation issues that impact billing.
Participate in EHR optimization, billing system upgrades, testing, and workflow redesign.
Track and improve key revenue cycle KPIs such as clean claims rate, days in A/R, denial rates, and collection performance.
Recommend workflow enhancements to improve efficiency, accuracy, and staff productivity.
Supervise the Billing Department and ensure staff are properly trained in BHCC policies, billing standards, and compliance requirements.
Conduct regular staff meetings, performance evaluations, and monthly rounding.
Develop strategies for team building and professional development.
Provide oversight of staff scheduling, workload distribution, and adherence to work standards.
Ensure timesheets are reviewed biweekly and overtime is properly controlled.
Prepare monthly billing, A/R, and collection reports for the Director of Patient Financial Services and senior leadership.
Participate in organizational meetings related to financial performance, compliance, audits, and grant programs.
Monitor KPIs including denials, collections, A/R aging, patient statements, and clean claims rate
Support revenue analysis for new BHCC initiatives, service expansions, and strategic planning.
Coordinate with Finance, IT, and clinical departments to ensure accurate reporting and resolution of billing issues.
Assist in budget planning for billing operations
Assist with internal and external audits, including HRSA, Low Income Pool (LIP) other grants site visits, Medicaid, Medicare, and payer reviews.