Insurance Manager - Medical Billing

Insurance Manager

Location: Toledo, OH (Preferred) | Hybrid/Remote Considered for Highly Qualified Candidates

About APS Medical Billing and Professional Consultants

APS Medical Billing and Professional Consultants is one of the nation's largest privately owned pathology and laboratory revenue cycle management companies. Since 1960, we have partnered with pathology groups, hospital laboratories, and reference laboratories across the United States to maximize reimbursement through specialty expertise, proprietary technology, and exceptional client service.

As we continue to expand our technology and payer connectivity initiatives, we are seeking an experienced Denial Management Manager to help lead our next phase of operational excellence.

Position Summary

The Insurance Manager will provide operational leadership for APS's denial management team while driving innovation across denial prevention, payer integration, workflow automation, and quality improvement initiatives. This individual will be responsible for ensuring timely resolution of denied claims, developing staff, improving operational performance, and partnering with executive leadership to implement new technologies and process improvements that enhance reimbursement outcomes.

This is an excellent opportunity for a revenue cycle leader who enjoys solving complex payer challenges, developing high-performing teams, and leveraging technology to improve operational efficiency.

Primary Responsibilities

• Lead the daily operations of APS's denial management department, ensuring timely and effective follow-up on denied and underpaid claims.
• Manage, coach, and develop denial management staff through regular performance evaluations, quality assurance reviews, and ongoing education.
• Monitor departmental productivity, quality, and key performance indicators while identifying opportunities for continuous improvement.
• Partner with Operations, Information Technology, Coding, Client Services, and Executive Leadership to improve denial workflows and reimbursement performance.
• Drive initiatives focused on workflow automation, payer connectivity, and operational efficiency.
• Assist in expanding direct payer API integrations and other electronic payer communication strategies to improve claim status visibility and accelerate reimbursement.
• Identify denial trends through data analysis and implement corrective actions, payer-specific edits, and workflow enhancements to reduce preventable denials.
• Develop and maintain department policies, standard operating procedures, and training materials.
• Participate in client meetings to discuss denial trends, reimbursement strategies, and operational improvement opportunities.
• Collaborate with software development and system engineering teams to prioritize system enhancements that improve denial management workflows.
• Ensure compliance with payer regulations, Medicare and Medicaid guidelines, and client-specific billing requirements.

Qualifications

• Minimum of five years of progressive revenue cycle management experience, including leadership responsibility for denial management or accounts receivable operations.
• Strong experience with pathology, anatomic pathology, molecular diagnostics, or clinical laboratory billing strongly preferred.
• Demonstrated experience managing commercial, Medicare, Medicaid, Blue Cross Blue Shield, and other government and commercial payer denials.
• Working knowledge of CPT, ICD-10-CM, modifier usage, NCCI edits, LCD/NCD policies, medical necessity requirements, and payer reimbursement methodologies.
• Experience managing multi-state pathology or laboratory billing operations preferred.
• Proven ability to analyze payer trends and develop operational solutions that improve reimbursement.
• Experience implementing workflow automation, system enhancements, or revenue cycle technology initiatives preferred.
• Strong analytical, organizational, and project management skills.
• Excellent written and verbal communication skills with the ability to interact effectively with clients, staff, and executive leadership.

Preferred Experience

Candidates will stand out if they have experience with:

• Pathology-specific denial management
• Multi-state payer reimbursement and jurisdictional requirements
• Payer API integrations and electronic connectivity initiatives
• Revenue cycle workflow automation
• Business intelligence, operational analytics, and KPI development
• Quality assurance and audit programs
• Staff development and leadership in high-volume production environments
• Root cause analysis and denial prevention strategies
• Cross-functional collaboration with software development and IT teams
• Claim submission

What Success Looks Like

The successful candidate will build upon APS's established denial management program while helping modernize the department through technology, automation, and data-driven decision making. This individual will foster a culture of accountability, continuous improvement, and exceptional client service while ensuring denied claims receive the highest level of attention and every appropriate reimbursement opportunity is pursued.

If you are an experienced revenue cycle leader who thrives in a fast-paced environment, enjoys solving complex reimbursement challenges, and wants to help shape the future of pathology revenue cycle management, we encourage you to apply.

Benefits Package includes

Paid Time Off

· Medical plan

· Health Savings Account

· Alight – Personal Health Care Advisor

· Dental, Vision, Life Insurance, 401K

· Paid holidays

· EAP - Employee Assistance Program

We are an Equal Opportunity Employer committed to a diverse workforce. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability.

Pay: $75,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Revenue cycle management: 5 years (Preferred)
• Management: 5 years (Preferred)
• Pathology: 1 year (Preferred)

Work Location: In person

Salary : $75,000 - $80,000