Billing Manager

Pivot Home Health; Denver (CO); Hybrid; USD 85,000 - 105,000; Full time

Job summary

Pivot Home Health is seeking a Billing Manager for a flexible hybrid role ideally located in the Denver Metro or Pueblo areas. You will oversee the accurate preparation and submission of medical claims, manage denials, and ensure compliance with HIPAA and payer guidelines.

You will lead a billing team, coordinate with outside vendors, and maintain expert knowledge of Medicare/Medicaid and commercial insurance billing to support the organization’s financial health.

Qualifications

• Minimum of 5 years of healthcare billing experience, preferably in home health or similar setting.
• Strong understanding of medical billing processes and payer guidelines.
• Familiarity with Medicare/Medicaid and commercial insurance billing.
• Knowledge of CMS-1500, ICD-10, CPT/HCPCS, and modifier usage.
• Ability to identify and resolve billing discrepancies with attention to detail.

Responsibilities

• Oversee claim submissions, payment posting, denial management, and accounts receivable.
• Ensure adherence to federal, state, and payer-specific billing regulations and policies.
• Track KPIs like denial rates, clean claim rates, and days in AR.
• Hire, train, and supervise billing staff; coordinate with outside vendors.
• Prepare and submit accurate claims to Medicare, Medicaid, and other payers.
• Monitor claim statuses and follow up on unpaid, denied, or underpaid claims.

Skills

Team leadership

Healthcare billing

Medicare/Medicaid billing

Billing accuracy

CMS-1500 familiarity

Job description

This position is a flexible hybrid role, ideally located in the Denver Metro or Pueblo areas

Job Summary

The Billing Manager is responsible fortheaccurateandtimelypreparation, submission, and follow-up of medical claims to payers. This role ensures all billing activities are performedin accordance withapplicable federal, state, and payer-specific guidelines. This position plays a key role in supporting the organization’s financial health and adherence to HIPAA regulations.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonableaccommodationmay be made to enable individuals with disabilities to perform these functions. Other duties may beassignedas necessary.

• Operations Oversight: Manages claim submissions, payment posting, denial management, and accounts receivable.
• Compliance & Policy: Ensures adherence to federal and state healthcare billing regulations and insurance policies.
• Data Analysis: Tracks key performance indicators like denial rates, clean claim rates, and days in accounts receivable.
• Team Leadership: Hires, trains, and supervises billing staff and coordinates with outside vendors.
• Prepare andsubmitaccurateclaims to Medicare, Medicaid, commercial insurance, and other third-party payers.
• Maintain a clear understanding of billing codes, modifiers, and payer requirements to minimize rejections and denials.
• Monitor claim statuses and follow up promptly on unpaid, denied, or underpaid claims.

Skills, Abilities, and Knowledge Requirements

• Team leadership experience.
• Minimum of 5years of healthcare billing experience, preferably in home health or similar healthcaresetting.
• Strong understanding of medical billing processes, including Medicare/Medicaid and commercial insurance.
• Familiarity with claim forms (e.g., CMS-1500), billing codes (ICD-10, CPT/HCPCS), and modifier usage.
• Strong attention to detail with the ability toidentifyand resolve billing discrepancies.
• Ability to work independently, manage multiple tasks, and meet deadlines in a fast-paced environment.
• Understandingofhealthcare documentation and how itimpactsbilling and reimbursement.