Healthcare Billing and Reimbursement Manager

Texoma Community Center•Sherman, TX

About The Position

The Healthcare Billing and Reimbursement Manager directs and supervises claims and provider reimbursement personnel, establishes procedures for filing reimbursement claims, and ensures claims are paid accurately and on time. The role monitors and reviews reports supporting reimbursement claims; develops policies and procedures that comply with fiscal and regulatory requirements and accepted accounting principles; and updates billing software with rates, codes, and procedures. The manager serves as the main point of contact with Managed Care Organizations (MCOs), Medicaid, Medicare, and commercial insurance plans for contracting, rate negotiation, dispute resolution, and staff roster submissions. The role oversees policies and procedures for client financial assessments and fee collection, including maximum monthly fees, copays, and deductibles, and provides Center staff oversight regarding training and completion of client financials, customer service, and collections. The manager also assists with developing and reconciling cost reports and other required state reporting, and may assist with special projects or assignments. The position operates under trauma-informed and recovery-oriented models of care aligned with CCBHC standards. Texoma Community Center emphasizes Trauma-Informed Care, considering the whole person, past trauma, and resulting coping mechanisms to support effective treatment and improve quality of care.

Requirements

Bachelor’s degree with major coursework in Business preferred; experience and education may be substituted.
Four years of supervisory responsibilities.
Excellent communication and organizational skills, with the ability to interact professionally with staff, clients, community agencies, and State agencies.
Extensive knowledge and skill in Microsoft Office applications, including Word, Access, and Outlook.
Current driver’s license and a vehicle for use while at work.
Self-motivated, organized, and detail-oriented.
Knowledge of Microsoft Office Suite.
Consistently practice the Trauma-Informed Model of Care and understand and consider the pervasive nature of trauma.
Knowledge of cultural differences and ability to work with individuals from different cultural backgrounds.
Ability to perform basic arithmetic and handle money or make change.
Ability to generate, read, interpret, and act on basic financial statements, national and state regulations, and operational, maintenance, and organizational policies and procedures.
Ability to communicate effectively, work cooperatively, maintain good working relationships, and identify problems.

Nice To Haves

Experience working with individuals with mental illness and/or addiction issues.
Ability to speak a second language relevant to the population served.

Responsibilities

Direct and supervise claims and provider reimbursement personnel.
Establish procedures for filing reimbursement claims and ensure timely and accurate claims payments.
Monitor, evaluate, and review reports supporting reimbursement claims.
Develop policies and procedures compliant with fiscal and regulatory requirements and accepted accounting principles.
Update billing software with rates, codes, and procedures.
Serve as the main contact with MCOs, Medicaid, Medicare, and commercial insurance plans regarding contracting, rate negotiation, dispute resolution, and staff roster submissions.
Develop and oversee policies and procedures for client financial assessments and fee collection, including maximum monthly fees, copays, and deductibles.
Provide oversight to Center staff on training and completion of client financials, customer service, and collections.
Assist in developing and reconciling cost reports and other required state reporting.
Assist a supervisor and/or other Center staff with special projects or assignments.
Operate according to trauma-informed and recovery-oriented care models aligned with CCBHC standards.