JOB SCOPE:

The Insurance and Billing Operations Manager is responsible for overseeing all insurance, billing, and eligibility functions across two mental health clinics. This role ensures that clients receive timely access to services, billing is accurate and compliant, and insurance inquiries and disputes are resolved efficiently. The Manager serves as the primary liaison between clinical teams, billing departments, insurance carriers, and administrative leadership, ensuring a seamless revenue cycle from intake through reimbursement.

ESSENTIAL FUNCTIONS:

Insurance Eligibility & Verification
•    Oversee the daily verification of insurance eligibility for new and returning clients.
•    Ensure authorizations, referrals, and required documentation are obtained prior to service.
•    Monitor ongoing eligibility changes and communicate updates to clinical and administrative teams.
•    Resolve complex eligibility issues, including lapses, denials, and changes in coverage.
Billing Oversight & Revenue Cycle Management
•    Manage the billing workflow for two mental health clinics, ensuring accurate and timely claim submission.
•    Monitor claim status, address rejections, and work closely with billing partners to resolve denials.
•    Conduct routine audits of billing accuracy, CPT coding alignment, and documentation compliance.
•    Track and report on revenue cycle KPIs (e.g., days in A/R, denial rate, clean claim rate).
Dispute Resolution & Insurance Communication
•    Serve as point person for escalated billing and insurance disputes from clients, staff, and insurance carriers.
•    Collaborate with insurance representatives to resolve reimbursement discrepancies or claim issues.
•    Maintain clear documentation of communications, appeals, and dispute resolutions.
Clinic Support & Collaboration
•    Partner with clinic leadership to ensure staff are following required insurance and billing procedures.
•    Train front-desk, intake, and clinical staff on eligibility workflows, documentation standards, and billing expectations.
•    Provide recommendations for process improvements to increase efficiency and reduce revenue loss.
Compliance & Quality Assurance
•    Ensure compliance with federal, state, and payer regulations, including HIPAA, OMH/DOHMH requirements, and insurer guidelines.
•    Keep leadership informed of insurance policy updates impacting billing or eligibility.
•    Develop and maintain SOPs for eligibility checks, billing escalations, and dispute resolution.
Insurance Contracting, Networking & Payer Relations
•    Build and maintain strong working relationships with insurance carriers and provider networks.
•    Serve as the primary contact for payer representatives regarding clinic billing, claims, credentialing, and operational needs.
•    Support negotiation, renewal, and implementation of insurance contracts, fee schedules, and authorization requirements.
•    Monitor contract performance and identify opportunities to expand payer participation and improve reimbursement rates.
•    Attend payer meetings, webinars, policy updates, and networking sessions to stay informed of changes impacting behavioral health services.
•    Collaborate with leadership to ensure compliance with payer standards, credentialing requirements, and regulatory updates.
 

EDUCATION AND EXPERIENCE:

•    Bachelor’s degree in Business, Healthcare Administration, Finance, or related field (Master’s preferred).
•    Minimum 5 years of experience in healthcare billing, insurance eligibility, or revenue cycle management (behavioral health preferred).
•    Strong knowledge of commercial plans, Medicaid, Medicare, and managed care.
•    Experience working with EHR and billing platforms.
•    Excellent communication, analytical, and problem-solving skills.
•    Ability to work independently, manage competing priorities, and support multiple clinic sites.

Salary : $79,824 - $90,000