Billing Manager en Leading Edge Administrators LLC

Description

Job Summary:

The Billing Manager is responsible for leading and optimizing the full billing cycle functions within a Third-Party Administration (TPA) environment. This role oversees day-to-day billing operations, ensures accuracy in claims and premium invoicing, and drives continuous improvements to maximize revenue integrity and cash flow. The Billing Manager will manage, train, and develop the billing team while ensuring alignment with payer rules, client contractual requirements, and regulatory standards.

Duties and Responsibilities:

• Manage billing staff and prepare/review bills to ensure accuracy and high-quality work products that are following regulatory agency guidelines.
• Oversee preparation, review, and submission of claims/premium invoices, ensuring compliance with payer guidelines, benefit plan provisions, and applicable regulations.
• Manage the auditing of billing data, account adjustments, aging, and reconciliation activities and identify variances or errors and drive corrective actions accordingly.
• Serve as a subject matter expert for billing practices, coding accuracy, and payer adjudication requirements.
• Monitor key performance indicators (KPIs) such as accounts billing error rate, monitor reasons for corrections made, receivable days, denial rates, and collection targets.
• Partner with internal departments, payer partners, clients, and external vendors to troubleshoot billing issues and support seamless integration of billing processes.
• Efficiently manage expenses of the department adhering to Finance guidelines.
• Ensure that all billing practices comply with federal, state, and local regulations, as well as insurance company guidelines.
• Oversee team adherence to documented billing workflows, SOPs, and internal controls.
• Lead audits, client reporting obligations, and communications with the clients.
• Manage and direct the resolution of complex billing functions and escalations, coordinating resources and decision-making to remove barriers.

Requirements

Required Knowledge, Skills, and Abilities:

• Bachelor’s degree in Business, Accounting, Finance, Healthcare Administration, or related field or equivalent experience required
• 4+ years of billing experience, preferably within a TPA, health insurance, or healthcare revenue cycle setting.
• Certified Professional Biller (CPB), Certified Review Cycle Professional (CRCP) or similar credential preferred
• Advanced knowledge of MS Excel including manipulation of large datasets, complex formulas and macros, pivot tables and power query.
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint
• Ability using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively individually and as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful.  
• Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment 
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively
• Teach, coach, and counsel associates by effectively communicating and providing follow-up.  
• Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.  

Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Occasional: Lift and/or move up to 10 pounds
• Occasional: Ability to uphold the stress of traveling 
• Constant: Regular, predictable attendance is required
• Constant: While performing the duties of this job, the employee is regularly required to stand or walk for the full shift. 
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending.

Work Environment: The work environment described is representative of what must be met by an employee successfully to perform the essential functions of this job.  

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.   

Pay may vary based on location. Offers will be adjusted based on an individual's experience, education, and other job-related factors as permitted by law.  Pay range is  $81,000-118,000/year