Billing Manager

POSITION PURPOSE:

The purpose of the Billing Manager position is to provide leadership, oversight, and operational direction for billing functions to ensure efficient revenue cycle performance. This includes managing billing staff, ensuring accurate charge capture and claims processing, maintaining compliance with payer and regulatory requirements, improving reimbursement outcomes, and supporting organizational financial goals through effective billing practices and process improvement initiatives.

QUALIFICATIONS:

• Bachelor’s degree in Healthcare Administration, Business, Finance, Accounting, or related field preferred; equivalent healthcare revenue cycle leadership experience may be considered in lieu of formal education
• Minimum of 3–5 years of healthcare billing or revenue cycle experience preferred, with progressive responsibility in billing operations
• Prior supervisory or leadership experience in a healthcare billing or revenue cycle setting strongly preferred
• Working knowledge of medical billing processes, payer requirements, claims management, denial resolution, and reimbursement methodologies (Medicare, Medicaid, commercial payers)
• Strong analytical, problem-solving, and decision-making skills with the ability to work independently and prioritize multiple tasks
• Proficiency with electronic health records (EHR), billing systems, and standard business software applications, preferably Oracle Cerner
• Effective verbal and written communication skills, including professional telephone etiquette and customer service approach
• Demonstrated attention to detail, organizational skills, and commitment to accuracy and compliance

GENERAL REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill, and / or ability required:

• Ability to add, subtract, multiply, and divide
• Ability to generate, read, interpret, and take action as it relates to basic financial statements, national and state regulations, safety rulings, operational and maintenance and organizational policies / procedures
• Ability to write reports and correspondence
• Ability to effectively present information to patients, families, employees, health care providers, etc...
• Ability to work cooperatively and communicate effectively to maintain good working relationships with staff and health care providers
• Ability to work with skill in identifying problems; making frequent decisions regarding method of performance

EQUIPMENT, TOOLS, MATERIALS:

• Calculator
• Computer and printer
• Fax and copy machine
• General office materials/supplies
• Information Systems
• Telephone system

SECURITY/ACCESS:

• Will have access to the facility 24 hours a day.
• Will have access to confidential information abiding by the organizations privacy policies and regulations concerning this information.

Essential Job Duties and Responsibilities:

1. Provides billing leadership and oversight of daily billing operations to ensure accurate claims submission, timely reimbursement, effective denial management, and overall revenue cycle efficiency. 

• Oversees daily billing operations, including charge capture, claims submission, payment posting, denial management, and accounts receivable follow-up to ensure timely and accurate reimbursement.

• Supports accurate revenue recognition through oversight of charge capture processes, charge review, and collaboration with clinical, coding, and finance teams to maintain billing integrity.

• Provides guidance and support to billing staff in preparing claim denials, appeals, and payer communications to maximize reimbursement outcomes.

• Ensures patient accounts are maintained accurately and in compliance with regulatory requirements, payer guidelines, and organizational policies.

• Monitors key billing performance metrics (e.g., AR days, denial rates, clean claim rates, reimbursement trends) and implements process improvements as needed.

• Promotes professional, accurate, and compassionate communication with patients regarding billing inquiries and financial responsibilities.

• Serves as the escalation point for complex billing issues, payer disputes, and patient concerns, facilitating timely resolution.

2. 

Provides oversight and coordination of payer relations and reimbursement processes to ensure accurate payment, regulatory compliance, and optimization of revenue cycle performance across all payer sources. 

• Maintains working knowledge of Medicare, Medicaid, and commercial payer requirements, reimbursement methodologies, and regulatory updates impacting billing and collections.
• Works collaboratively with the Revenue Cycle Analyst to review reimbursement variances, identify trends, and implement corrective actions to improve payment accuracy and financial performance.
• Collaborates with finance, coding, clinical departments, and revenue cycle leadership to optimize reimbursement outcomes and address payer-related issues proactively.
• Assists in monitoring payer performance, denial patterns, and reimbursement trends to support process improvement and contract optimization initiatives.

3. Oversees identification, review, and timely resolution of patient payer credit balances, including processing refunds in accordance with regulatory requirements, payer guidelines, and organizational policies.

• Oversees identification and timely resolution of patient and payer credit balances, ensuring compliance with regulatory requirements and organizational policies.
• Ensures accurate processing of refunds, including appropriate documentation, approvals, and reconciliation of accounts.
• Collaborates with billing, finance, and compliance staff to investigate credit balance trends and implement process improvements as needed.
• Supports audit readiness and compliance efforts related to overpayments, refunds, and billing accuracy.

4. Provides leadership, direction, and development of billing staff to promote a high-performing, accountable team focused on revenue cycle excellence, regulatory compliance, and exceptional patient service. 

• Supervises billing staff including recruitment, onboarding, training, performance evaluation, coaching, and professional development to ensure strong team performance and engagement.
• Utilizes the Custom Learning Systems framework to conduct regular staff rounding, coaching conversations, and engagement initiatives that support a culture of service excellence and continuous improvement.
• Promotes accountability, productivity, and high-quality customer service within the billing team while fostering collaboration, professionalism, and a positive work environment.
• Provides ongoing education and communication regarding regulatory updates, payer requirements, compliance expectations, and revenue cycle best practices to ensure staff knowledge remains current.

5. Provides compliance and regulatory oversight of billing operations to ensure adherence to federal and state regulations, payer requirements, organizational policies, and industry best practices while supporting accurate reimbursement and risk mitigation.

• Ensures billing practices comply with HIPAA, CMS guidelines, payer contract requirements, and applicable federal and state regulations.
• Supports organizational compliance initiatives, including internal and external audits, documentation standards, policy adherence, and corrective action planning when necessary.
• Maintains awareness of Critical Access Hospital regulatory requirements and reimbursement considerations, incorporating regulatory changes into billing processes and staff education as appropriate.

6. Provide collaboration and organizational support across departments to strengthen revenue cycle performance, operational efficiency, financial outcomes, and alignment with organizational strategic goals.

• Works closely with finance, revenue cycle, clinical departments, administration, and other stakeholders to support financial performance, operational effectiveness, and coordinated revenue cycle processes.
• Participates in committees, performance improvement initiatives, cross-functional projects, and organizational planning activities as assigned to support continuous improvement and organizational priorities.
• Supports budgeting, forecasting, reporting, and strategic revenue cycle initiatives through data analysis, operational insight, and collaboration with leadership teams.

7. Follows HIPAA regulations and ensures that the confidentiality of patients’ medical, personal, financial records, employee records, and organizational records is maintained. 

8. Participates in FCH committees, quality assurance, performance and quality improvement initiatives, and activities which support the facility and department operations.

9. Complies with the state and federal regulatory requirements related to the performance of FCH operations and requirements of the FCH Compliance Program.  Including but not limited to:

• The Compliance Policy.
• Completes all on-line training annually and as assigned.
• All department and organization-wide policies.
• Considers the impact of regulations such as Critical Access Hospital requirements, along with Federal and State of Nebraska regulations and discusses concerns appropriately to ensure compliance.

10. Presents self in a professional manner and enhances professional growth and development through participation in education programs, current literature, in-service meetings and workshops.

• Seeks opportunities for continued growth and performance improvement.
• Always maintains a professional appearance and manner.
• Dependable and completes work in a timely manner.
• Demonstrates an understanding and emphasis on quantity, quality and knowledge of duties and tasks.

11. Performs other duties as assigned

Essential Standards of Service Excellence:

1. Abides by Fillmore County Hospitals Standards of Professional Courtesy and Respect which include:
   • Communication & Interaction
   • Customer Service & Respect
   • Teamwork
   • Telephone Communication
   • Safety, Pride &Ownership
   • Professional Appearance
2. Abides by Fillmore County Hospitals Core Values 1-12 which include:
   • Authenticity
   • Integrity
   • Awareness
   • Courage
   • Perseverance
   • Faith
   • Purpose
   • Vision
   • Focus
   • Enthusiasm
   • Service
   • Leadership

ESSENTIAL WORK ENVIRONMENT & PHYSICAL REQUIREMENTS:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.