Billing Manager | Medicare AR
About The Position
The Billing Operations & Medicare AR Manager is responsible for overseeing Hospital Billing (HB) and Professional Billing (PB) billing operations, ensuring the timely and accurate submission of claims, resolution of claim edits and rejections, management of Direct Data Entry (DDE) activities, and optimization of billing workflows. This role also provides leadership for Medicare Accounts Receivable (AR) management, focusing on reducing aging, resolving reimbursement issues, recovering underpayments, and improving overall collection performance. The manager leads billing and Medicare AR teams, drives operational excellence, ensures compliance with Medicare regulations, and partners with internal stakeholders to maximize reimbursement and minimize revenue leakage across both facility and professional billing operations.
Requirements
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field
- Equivalent combination of education and experience may be considered
- 5+ years of experience in healthcare billing operations
- 3+ years of leadership experience managing billing and/or accounts receivable teams
- Extensive experience with both Hospital Billing (HB) and Professional Billing (PB) operations
- Strong Medicare billing and AR management experience
- Experience working with Medicare DDE
- Comprehensive understanding of Medicare billing regulations, DDE processes, claim edits and rejections, hospital billing (HB), professional billing (PB), Medicare AR follow-up and collections, as well as denial management and appeals
- Knowledge of UB-04 and CMS-1500 claim processing
- Strong analytical and problem-solving skills
- Experience with Epic Resolute HB/PB
- Excellent communication and leadership abilities
Responsibilities
- Manage day-to-day Hospital Billing (HB) and Professional Billing (PB) billing operations
- Oversee claim generation, claim validation, and claim submission processes.
- Monitor and resolve billing edits, front-end claim rejections, and payer submission issues
- Manage Medicare Direct Data Entry (DDE) activities, including claim corrections, status reviews, RTP (Return to Provider) claims, and billing issue resolution
- Ensure claims are submitted accurately and within established filing deadline
- Develop and implement processes to improve clean claim rates and reduce avoidable rework
- Monitor billing work queues and productivity standards
- Coordinate with Coding, Revenue Integrity, Patient Financial Services, and Clinical departments to resolve billing-related issues
- Ensure compliance with Medicare, Medicaid, and commercial payer billing requirements
- Oversee Medicare AR follow-up activities for both HB and PB accounts.
- Monitor Medicare aging inventories and prioritize collection efforts.
- Manage resolution of unpaid, partially paid, and denied Medicare claims.
- Review and resolve RTP claims, denials, underpayments, medical necessity issues, coverage-related denials, and billing-related reimbursement delays
- Ensure timely and effective appeal submission when appropriate.
- Identify denial and AR trends and implement corrective action plans.
- Work closely with billing teams to address root causes impacting Medicare reimbursement
Benefits
- flexible work hours
- Access to a 401(k) Retirement Savings Plan.
- Comprehensive Medical, Dental, and Vision Coverage.
- Paid Time Off.
- Paid Holidays.
- Pet Care Coverage
- Employee Assistance Program (EAP)
- discounted services
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What This Job Offers
Job Type
Full-time
Career Level
Manager
