Billing and Claims Mgr

Position Summary: The Manager of Billing and Claims is responsible for the leadership, development, coordination, implementation and oversight of all billing functions. The Manager will conduct and monitor charge behavior analysis to ensure maximized and accurate charge capture and revenue recognition.

Essential Responsibilities:

• Manage the full billing and claims cycle, charge review, claim creation, and submission. 
• Establish and enforce workflow processed that achieve targeted KPIs
• Supervise a team of billing specialists, ensuring accurate processing and prompt action on rejected claims.  
• Review claims for accuracy and completeness, especially for common eyecare procedures (e.g., refractions, OCTs, visual fields, cataract surgery, injections). 
• Ensure proper billing to both medical (e.g., Medicare, BCBS, Aetna) and vision (e.g., VSP, Eyemed) payers, understanding coordination of benefits. 
• Resolve billing and coding discrepancies in collaboration with clinical and coding teams. 
• Monitor rejection trends and implement corrective actions to improve first-pass claim acceptance rates. 
• Work closely with operational training teams to minimize registration errors and verify insurance benefits prior to service. 
• Generate and analyze billing and claims reports, including aging reports, claim status logs, and rejections by payer or reason code. 
• Ensure compliance with HIPAA, CMS, and payer-specific billing rules and guidelines. 
• Assist with training and onboarding of new billing staff and maintain up-to-date documentation of workflows and payer requirements. 
• Support software optimization and upgrades for EHR/PM system (e.g., Compulink EyeMD, Waystar). 

Education and Knowledge:

• Bachelor's Degree in business or related field preferred
• Coding Certification strongly preferred – CPC, CCS or COC
• 5 years in a supervisory role
• Excellent knowledge of governmental and 3rd party reimbursement structures