Billing Manager & Credentialing Administrator

Lead Revenue, Drive Impact: Billing Manager & Credentialing Administrator Full-Time | Exempt | Remote Schedule: Monday – Friday, 8:30 AM – 5:00 PM (PST) Reports to: Director of Finance Compensation: $75,000 – $90,000 (depending on experience)

About the Role

We’re seeking a dynamic and results-driven Billing Manager & Credentialing Administrator to lead our medical billing team and elevate financial performance. This is a high-impact leadership role responsible for optimizing billing workflows, strengthening payer relationships, and ensuring compliance across all aspects of the revenue cycle. If you’re someone who thrives on improving processes, leading teams, and driving measurable results, this role is for you.

Key Responsibilities

Revenue Cycle & Billing Operations Management

• Lead and manage Billing Specialist and Patient Account Specialist teams, including billing, denial management, collections, reimbursement, and eligibility verification
• Ensure timely and accurate billing, invoicing, and claim submission
• Oversee adherence to billing policies, procedures, and payer guidelines
• Identify operational issues (EDI errors, payer changes, system issues) and implement corrective actions
• Ensure claims are reviewed and confirmed within two business days of date of service (DOS)
• Provide coverage for team members absent more than four business days

Accounts Receivable & Collections Performance

• Monitor and manage all AR activity to ensure timely collections and strong cash flow
• Maintain and drive performance benchmarks:
• Improve collections over 90+ days by at least 30% month-over-month
• Limit 120+ day AR to no more than 15% of total receivables
• Track insurance and patient balances from DOS and account creation
• Analyze monthly AR aging reports to identify trends and improvement opportunities

Claims Management & Follow-Up

• Ensure complete and accurate documentation (prescriptions, clinical records, delivery tickets)
• Verify claims meet payer requirements (ICD-10, HCPCS, CPT) prior to submission
• Resolve issues such as missing authorizations, documentation gaps, and inventory discrepancies
• Oversee third-party claim follow-up vendors to ensure adherence to SOPs
• Review escalated claims and implement resolutions
• Ensure revenue cycle worklists are completed within established timelines

Patient Accounts & Customer Service Oversight

• Ensure Patient Accounts team meets established patient collection goals
• Oversee third-party billing customer service vendors (e.g., Brightree Live Agent Services) to ensure quality and compliance

Operational Workflow & System Management

• Monitor and resolve system alerts, work queues, and hold/stop reports
• Address issues such as missing pricing, manual holds, and billing system flags
• Ensure Compliance and New Insurance teams meet required timelines
• Complete monthly billing pre-closing processes within established deadlines

Cross-Functional Collaboration & Support

• Support Patient Relations in addressing insurance-related inquiries by providing billing expertise
• Partner with the Qualification Team to ensure accurate insurance verification for new patient referrals
• Serve as a subject matter expert on billing, insurance criteria, and reimbursement processes
• Mentor and train staff to improve collection performance and efficiency

Credentialing & Contract Administration

• Manage credentialing for all new and existing payer contracts
• Maintain contract files, payer relationships, and centralized database
• Monitor and evaluate fee schedules to optimize reimbursement
• Track contracted plans, NPIs, and insurance portal access
• Coordinate updates with payers (locations, provider changes, etc.)
• Conduct quarterly reviews of payer medical policies (e.g., OSA trends)
• Monitor HCPCS and CPT updates and assess operational impact
• Support contract negotiations and implementations
• Review and approve Letters of Agreement for Workers’ Compensation referrals

Qualifications & Skills

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred (or equivalent experience)
• 5–8+ years of medical billing or revenue cycle experience
• 2–4+ years of leadership experience
• Strong knowledge of billing operations, AR management, and insurance reimbursement

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