Sr. Medical Billing Manager

Community Connections, Inc.; Washington (District of Columbia); Hybrid; USD 80,000 - 95,000; Full time

Benefits offered by this job

Paid time off

Medical, Dental, and Vision Insurance

Flexible Spending Accounts

Long-term disability and life保险

Voluntary life insurance

Employee Assistance Program

403(b) Retirement plan

Educational assistance after one year

CEU & Licensure reimbursement

Professional and leadership developmen

Job summary

Community Connections, Inc. is seeking a Senior Medical Billing Manager to oversee the billing process, coding, and reimbursement, with emphasis on Medicaid. You will lead staff, ensure accuracy, and resolve discrepancies while communicating with insurers and payers.

The role requires strong knowledge of claims management, HIPAA, and CMS requirements. This position offers a hybrid work arrangement and opportunities to drive process improvements across the revenue cycle.

Qualifications

• Bachelor’s degree in finance or accounting relevant field or equivalent experience.
• 5-7 years of medical billing experience required.
• Strong knowledge of basic accounting principles.
• Possesses intermediate computer skills with demonstrated strengths in Excel and EHR software.
• Minimum of 5 years experience in progressive management position with proven track record of managing a team to achieve results.
• Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, ICD-9 and 10, and HCPCS coding
• Ability to successfully communicate and interact with all levels of individuals within the organization
• Collaborative skills to form strong working relationships with vendors, other departments, and senior management
• SmartCare by Streamline experience a plus

Responsibilities

• Oversee revenue management including satisfying timely filing requirements, maximizing billing revenue and collections, and resolution of denied/rejected claims.
• Oversee posting, tracking, and reporting on claim transactions, and complete corrections for denied claims to ensure timely collections.
• Perform monthly and yearly account reconciliations for fee-for-service revenue and AR general ledger accounts.
• Develop and execute a collection strategy for outstanding receivables and unbillable claims to maximize revenue.
• Create reporting to analyze fee-for-service program performance.
• Create reporting to analyze managed care program performance, integrating clinical and billing data.
• Assist with CECL calculations for financial reporting and provide ongoing support quarterly.
• Supervise revenue cycle and billing staff and provide evaluations and mentoring.

Skills

Medical billing

Staff management

Communication with payers

CMS requirements knowledge

Excel proficiency

HIPAA knowledge

Team leadership

Education

Bachelor’s degree in finance or accounting relevant field

Tools

EHR software

SmartCare by Streamline

Job description

POSITION TYPE: Hybrid

PAY RANGE: $80,000 - $95,000 depending on years of experience

Position Summary

The Senior Medical Billing Manager is responsible for oversight and execution of the billing process, including billing claims, coding, and reimbursement. This involves monitoring billing information to ensure accuracy and resolving any discrepancies. This person must be knowledgeable in medical coding and reimbursement regulations, especially for Medicaid, and be able to communicate effectively with insurance companies and other payors. The Senior Medical Billing Manager is also responsible for training and supervising staff and providing on‑going support.

Key Responsibilities

• Performs overall revenue management including satisfying timely filing requirements, maximizing billing revenue and collections, and resolution of denied/rejected claims
• Responsible for the oversight of timely posting, tracking, and reporting on claim transactions, and completing corrections for denied claims to ensure collections in a timely manner. Provides coverage when billing manager is out of office and assists with process to ensure it is completed on a contemporaneous basis
• Perform account reconciliations on a monthly and yearly basis for fee‑for‑service revenue and accounts receivable general ledger accounts
• Responsible for review and reporting, as well as developing and executing, a collection strategy for outstanding receivables and unbillable claims, to maximize revenue and collectability
• Create reporting, as necessary, to facilitate analysis of fee‑for‑service program performance
• Create reporting, as necessary, to facilitate analysis of managed care program performance, including the integration of necessary clinical information with billing information in pay‑for‑value reimbursement model
• Assist with implementation of Current Expected Credit Loss (CECL) calculations for financial reporting and provide on‑going support in updating the calculation on a quarterly basis
• Supervise revenue cycle and billing staff
• Write formal staff evaluations, provide feedback to the staff and offer mentoring opportunities to allow staff to grow and achieve agency outcomes
• Develops, implements, and maintains revenue cycle standard operating procedures
• Researches and maintains compliance with all governmental billing regulations
• Develops relationships with all payers
• Attend provider meetings with respective payers such as Department of Behavioral Health (District of Columbia) or commercial insurers, as well as internal meetings with program heads and senior leadership on occasion
• Lead and work effectively in a team environment

Other Responsibilities

• Models and reinforces Community Connections mission to provide behavioral health, residential services, and primary health care coordination for marginalized and disenfranchised women, men, youth, and children living in the District of Columbia, many of whom are coping with challenges including mental illness, addiction, and the aftermath of trauma and abuse
• Models and reinforces Community Connections values of quality, innovation, respect, equity, and integrity daily
• Reinforces Community Connection’s commitment to diversity, equity, and inclusion
• Protects the privacy of our consumer’s protected health information by maintaining compliance with HIPAA and other relevant CC related IT security regulations
• Completes and stays current on role specific and organizational wide training
• Performs other duties as assigned on an as‑needed basis

Desired Knowledge / Skills / Abilities

• Bachelor’s degree in finance or accounting relevant field or equivalent experience
• 5‑7 years of medical billing experience required
• Strong knowledge of basic accounting principles
• Possesses intermediate computer skills with demonstrated strengths in Excel and EHR software
• Minimum of 5 years experience in progressive management position with proven track record of managing a team to achieve results
• Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, ICD‑9 and 10, and HCPCS coding
• Ability to successfully communicate and interact with all levels of individuals within the organization
• Collaborative skills to form strong working relationships with vendors, other departments, and senior management
• SmartCare by Streamline experience a plus

Community Connections Offers Great Benefits Including

• Generous paid time off, including sick, vacation, and 9 paid holidays
• Medical, Dental, and Vision Insurance
• Medical and Dependent Flexible Spending Accounts
• Agency paid Long‑term disability and life insurance
• Employee paid Voluntary life insurance
• Employee Assistance Program
• 403(b) Retirement plan
• Educational assistance after one year of employment
• CEU & Licensure reimbursement
• Professional and leadership development to include supervision hours for those on track for clinical licensure