Manager, Claims Audit, Billing

IQVIA•Houston, TX

2d•$73,400 - $183,600•Hybrid

About The Position

Cedar Gate Technologies, an IQVIA business, enables payers, providers, employers, and service administrators to excel at value-based care with a unified technology and services platform delivering analytics, care, and payment technology on a single data management foundation. At Cedar Gate, you’ll be part of a collaborative, innovative environment where great ideas thrive. We invest deeply in our people through ongoing training, comprehensive benefits, and a strong culture of teamwork, offering the chance to grow your skills while contributing to high impact initiatives for some of the world's most dynamic companies. As the Collections Manager, Value-Based Care (VBC) Operations, you will lead the collections function for a portfolio of specialty care provider clients, ensuring strong financial performance, operational excellence, and exceptional client satisfaction. You will oversee a team of Collection Representatives, drive revenue cycle performance, and play a critical role in optimizing billing and collections processes within a growing value-based care environment. Leveraging your expertise in medical billing, collections, and payer reimbursement methodologies, you will develop and implement best practices, establish performance metrics, and guide the team in achieving operational and financial goals. You will analyze reimbursement trends, interpret payer contracts, oversee complex collection activities, and identify opportunities to improve efficiency and outcomes across the revenue cycle. Success in this role requires a strategic mindset, strong leadership capabilities, and the ability to collaborate effectively across departments. As a key member of the VBC Operations team, you will help shape processes, drive continuous improvement initiatives, and ensure providers receive the reimbursement they have earned while delivering a high level of service to clients and stakeholders.

Requirements

5+ years of related experience in collections and prior authorization
Knowledge of revenue cycle management for various specialty groups, preferably with Maternity, Ortho, or Cardiovascular.
Significant experience in making and implementing impactful decisions in complex environments where collaboration and consensus are key.
Ability to analyze, evaluate, and develop solutions and financial needs strategically, logically, and realistically.
Demonstrates strong leadership abilities and is perceived as confident, empathetic, and authentic.
Possesses effective negotiation skills with both external and internal stakeholders.
Bachelor's in healthcare, business, or a related field
Has a thorough knowledge of industry best practices to continually enhance and improve processes related to bundles and claims.
Fosters teamwork and strives to maximize the potential of all employees.
Exceptional oral and written communication skills, along with strong interpersonal and customer service skills, are essential.
Extensive familiarity with value-based care operations, including bundled payments.
To be eligible for this position, you must reside in the same country where the job is located.

Nice To Haves

Master's Degree in a healthcare-related field
15+ years of related experience in collections
3+ years of management experience overseeing collections, billing, or revenue cycle management

Responsibilities

Directs resolving technical or workflow-related issues causing revenue cycle deficiencies in collections and provider inquiries.
Completes daily collection and billing KPIs audit to maintain updated knowledge on overall performance.
Responsible for all collection, billing, and management reporting
Monitors employee progress during orientation for achievement of competencies and goals.
Completes annual employee reviews, including 45-day and 90-day orientation interim evaluations, in a timely manner.
Identifies, prioritizes, and implements improved processes to increase efficiency and effectiveness of the department.
Collaborates with other departments on identified quality and efficiency initiatives.
Assist with developing and revising VBC policy and procedures as needed.
Ensures adequate controls are in place to ensure that inquiries and account resolution are sustainable over time as the organization's volume grows rapidly.
Manage the hiring, training, and development of the team to ensure the efficient operation of the function and the follow-through of company policies and procedures.