Senior Manager, Billing Operations

OSSWF•Fort Myers, FL

6d•Onsite

About The Position

Join Orthopedic Specialists of SW Florida as Director of Revenue Cycle Operations, where you will play a crucial role in overseeing and optimizing the operational aspects of our Billing Department. With a focus on the oversight of the revenue cycle to maximize revenue utilizing the most innovative and effective processes. About OSSWF: Orthopedic Specialists of SW Florida has been a cornerstone of orthopedic care in the Fort Myers area for over 23 years. Our practice boasts a team of 18 fellowship-trained orthopedic surgeons specializing in various subspecialities. We are committed to excellence and continued growth, offering comprehensive services including onsite Physical Therapy/Occupational Therapy, MRI, and digital X-ray. We prioritize patient care and strive for the highest standards of service. Orthopedic Specialists of SW Florida’s state-of-the-art, 60,000 square-foot facility incorporates the latest in leading-edge technology in order to provide optimal care for patients who have bone, joint, muscle and spine problems. Our office includes a full Physical Therapy and Occupational/Hand Therapy division, which work in close coordination with our physicians to provide non-operative, preoperative, post-operative and preventive care.

Requirements

Minimum 7 years of progressive healthcare billing, reimbursement, or related healthcare financial operations experience.
Minimum 3 years of management or supervisory experience overseeing billing functions, teams, or outsourced billing operations.
Experience in a large physician practice, multispecialty group, orthopedic practice, ambulatory surgery center, or healthcare organization preferred.
Demonstrated experience improving billing performance, accounts receivable, reimbursement accuracy, and operational efficiency.
Experience managing outsourced billing vendors and third-party service providers.
Experience with payer relations, reimbursement analysis, denials management, and billing system optimization preferred.
Experience with Auto/PIP and Workers' Compensation reimbursement, fee schedules, carrier negotiations, settlement evaluation, and regulatory compliance preferred.
Strong knowledge of healthcare billing, reimbursement methodologies, and billing operations.
Understanding of coding, compliance, payer regulations, and revenue integrity principles.
Strong analytical, financial, and reporting skills.
Ability to interpret billing, reimbursement, and operational data.
Strong leadership, communication, negotiation, and relationship-building skills.
Effective project management and process improvement capabilities.
Proficiency with EHR, practice management, and billing systems, including Epic experience preferred.
Ability to manage competing priorities, meet deadlines, and work collaboratively with internal departments and external vendors.

Nice To Haves

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Health Information Management, or a related field preferred.
Equivalent progressive healthcare billing, reimbursement, and operational management experience may be considered in lieu of a degree.
CPC, CPB, CRCR, RHIA, RHIT, CHFP, or equivalent healthcare billing or reimbursement certification.
Epic experience preferred.

Responsibilities

Direct and coordinate daily billing activities, including insurance verification, prior authorization coordination, charge capture, coding coordination, claims submission, payment posting, denial management, and collections.
Monitor daily claim volumes, rejections, billing backlogs, outstanding accounts, and unresolved reimbursement issues.
Ensure timely and accurate processing of claims and appropriate follow-up on unpaid claims, outstanding balances, and payer discrepancies.
Review operational billing workflows and identify delays, errors, and inefficiencies affecting productivity and reimbursement.
Coordinate resolution of billing issues between internal teams, clinical departments, and outsourced billing partners.
Maintain standardized billing procedures and ensure consistent implementation across internal operations and third-party services.
Monitor charge lag, payment posting timeliness, claim submission timeliness, and accounts receivable follow-up activities.
Coordinate the implementation of operational initiatives approved by the Chief Executive Officer.
Monitor daily and monthly billing performance against established operational KPIs and productivity expectations.
Prepare and validate billing reports covering accounts receivable, clean claim rates, denial rates, first-pass claim acceptance, cash collections, and outstanding reimbursement issues.
Identify unfavorable performance trends and implement operational corrective actions within established authority.
Coordinate denial prevention, appeals, claim corrections, and recovery efforts with internal staff and outsourced billing partners.
Monitor payer payment accuracy and identify underpayments, reimbursement discrepancies, and unresolved payment issues.
Coordinate follow-up and recovery efforts for underpaid or incorrectly processed claims.
Escalate significant financial trends, systemic reimbursement problems, and issues requiring executive approval to the Chief Executive Officer.
Provide the Chief Executive Officer with accurate and timely billing, reimbursement, accounts receivable, collections, denial, and operational performance data needed for Finance Committee and Board meetings.
Prepare supporting reports and analysis regarding billing and collections trends, significant variances, reimbursement issues, and other operational matters with potential financial impact.
Maintain working relationships with payer representatives, Medicare, Medicaid, Workers' Compensation carriers, third-party administrators, and other operational billing contacts.
Coordinate resolution of routine payer disputes, claim rejections, payment discrepancies, and reimbursement inquiries.
Monitor payer policy changes and communicate operational requirements to billing staff and appropriate departments.
Implement approved payer reimbursement updates, fee schedule changes, and billing policy revisions.
Coordinate operational Workers' Compensation billing activities, including carrier requirements, statutory billing changes, and claim follow-up.
Manage operational processing and follow-up of personal injury and PIP accounts in accordance with applicable requirements and approved organizational procedures.
Coordinate the preparation of account documentation and settlement information for personal injury matters, referring settlement decisions and significant negotiations to authorized executive leadership.
Support the operational review and implementation of approved payer contract and reimbursement changes.
Serve as the primary operational liaison between the organization and outsourced billing companies, coding vendors, collection agencies, clearinghouses, and other service providers.
Manage daily vendor communication, workflow coordination, account assignments, and issue resolution.
Monitor vendor performance against established productivity, quality, service, and reporting standards.
Review vendor reports and verify appropriate follow-up on outstanding claims, denials, payment discrepancies, and collection activities.
Conduct regular operational performance reviews with vendors and document performance concerns and corrective actions.
Coordinate workflow changes, training, and process improvements with outsourced billing partners.
Monitor vendor compliance with approved procedures, service expectations, and contractual requirements.
Escalate unresolved vendor performance issues, material contractual concerns, and significant financial risks to the Chief Executive Officer.
Oversee operational billing requirements specific to orthopedic and musculoskeletal services.
Coordinate billing activities for surgical procedures, office visits, diagnostic services, ancillary offerings, and other orthopedic services.
Monitor appropriate billing for global surgical periods, surgical modifiers, and specialty-specific reimbursement requirements.
Coordinate with physicians, clinical staff, coding personnel, and documentation teams to resolve billing and coding issues.
Support appropriate reimbursement processes for orthopedic products, implants, and other applicable services.
Ensure operational compliance with Workers' Compensation, PIP, and other specialty payer billing requirements.
Communicate specialty billing issues and reimbursement trends to the Chief Executive Officer.
Serve as the operational subject matter expert for billing, practice management, clearinghouse, and electronic health record systems.
Coordinate billing system workflow improvements, system testing, upgrades, and operational implementation in collaboration with Information Technology.
Support Epic and other billing system implementations, including billing workflow validation, user acceptance testing, and staff training.
Identify opportunities to improve billing accuracy, data integrity, reporting, and automation.
Coordinate resolution of system-related billing issues with Information Technology, vendors, and operational users.
Ensure billing system procedures and workflows are maintained in accordance with approved operational standards.
Communicate system limitations, resource requirements, and significant technology improvement opportunities to the Chief Executive Officer.
Ensure daily billing activities comply with applicable federal and state regulations, payer guidelines, and approved organizational policies.
Monitor adherence to HIPAA, Medicare, Medicaid, commercial payer, Workers' Compensation, and applicable billing requirements.
Coordinate billing audits, documentation reviews, and operational compliance assessments.
Identify billing errors, documentation deficiencies, and process risks and implement corrective actions within established authority.
Maintain operational quality assurance procedures and monitor compliance with established billing standards.
Coordinate staff education regarding billing requirements, coding updates, payer policies, and regulatory changes.
Escalate significant compliance concerns, audit findings, and potential financial or regulatory exposure to the Chief Executive Officer.
Directly supervise and manage internal billing staff, including hiring recommendations, onboarding, training, performance evaluations, and professional development.
Assign workloads, establish schedules, and monitor staffing levels to meet daily departmental requirements.
Communicate operational expectations, productivity standards, and quality requirements to billing personnel.
Monitor individual and team performance and provide coaching, mentoring, and corrective feedback.
Address routine employee performance concerns and recommend disciplinary action in accordance with organizational policies.
Develop and maintain billing procedures, training materials, and operational reference resources.
Foster teamwork, accountability, efficiency, and professional customer service within the billing department.
Coordinate internal staff activities with outsourced billing partners to maintain consistent operational practices.