Billing Manager

Pivothh; Denver (CO); Hybrid; USD 80,000 - 110,000; Full time

Job summary

Pivothh in the Denver metro area is seeking a Billing Manager to oversee the accurate preparation, submission, and follow-up of medical claims with payers. This role ensures all billing activities comply with federal, state, and payer guidelines, and supports the organization’s financial health and HIPAA compliance.

You will lead a billing team, manage denials, monitor days in accounts receivable, and coordinate with outside vendors to optimize cash flow.

Qualifications

• Minimum of 5 years of healthcare billing experience, preferably in home health or similar setting.
• Strong understanding of Medicare/Medicaid and commercial insurance billing.
• Experience with CMS-1500, ICD-10, CPT/HCPCS and modifiers.

Responsibilities

• Oversee claim submissions, payment posting, denial management, and accounts receivable.
• Ensure adherence to federal and state healthcare billing regulations and insurance policies.
• Track KPIs such as denial rates, clean claim rates, and days in accounts receivable.
• Hire, train, and supervise billing staff and coordinate with outside vendors.
• Prepare and submit accurate claims to Medicare, Medicaid, commercial payers, and other third-party payers.
• Maintain knowledge of billing codes, modifiers, and payer requirements to minimize denials.
• Monitor claim statuses and follow up promptly on unpaid, denied, or underpaid claims.

Skills

Team leadership

5+ years healthcare billing

Medicare/Medicaid billing

CMS-1500 knowledge

ICD-10 CPT/HCPCS

Attention to detail

Independent worker

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.