Operations Manager (Medical Billing)

Job Summary:

We are looking for a highly skilled Operations/ Project Manager with expertise in  Medical Billing to oversee and optimize revenue cycle operations, manage billing teams, and ensure compliance with industry regulations. The ideal candidate will have strong expertise in medical billing, claims management, and healthcare compliance, along with leadership and project management skills to drive efficiency and profitability.

Key Responsibilities:

1. Project & Team Management

Lead and oversee medical billing teams, ensuring smooth workflow and process execution.

Assign tasks, monitor team performance, and ensure that SLAs (Service Level Agreements) are met.

Manage the end-to-end revenue cycle process, from claim submission to payment reconciliation.

Conduct regular status meetings to review billing performance and resolve recurring issues.

2. Medical Billing & Revenue Cycle Oversight

Ensure accurate claim submission, coding, and denial management.

Monitor and analyze AR (Accounts Receivable) reports, reducing outstanding payments.

Work closely with insurance payers to address denials, rejections, and appeals.

Stay updated with Medicare, Medicaid, commercial insurance policies, and HIPAA compliance.

3. Process Improvement & Compliance

Implement best practices to optimize claim submission and payment posting workflows.

Maintain strict adherence to HIPAA, ICD-10, CPT, and HCPCS coding standards.

Identify revenue leaks and create strategies for improving collection efficiency.

Conduct internal audits and compliance checks to prevent billing fraud or errors.

4. Client & Stakeholder Management

Serve as the primary point of contact for healthcare clients and outsourcing partners.

Present financial reports, performance metrics, and improvement plans to senior management.

Coordinate with medical coders, AR specialists, and patient account representatives to ensure timely collections.

Handle client escalations and resolve disputes regarding billing errors or payment issues.
 

5. Technology & Reporting

Utilize EHR and medical billing software (e.g., Epic, Kareo, eClinicalWorks, AdvancedMD).

Track KPIs such as claim denial rates, collection rates, and processing time.

Implement automation tools to improve billing efficiency and reduce manual errors.

Qualifications & Experience:

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field
• At least 5 years of experience in revenue cycle management in general and in medical billing in particular
• 2-3 years of project management or team leadership experience in healthcare billing.
• Strong knowledge of ICD-10, CPT, HCPCS, HIPAA, and insurance payer rules.
• Proficiency in medical billing software (e.g., Epic, Athenahealth, AdvancedMD, Kareo, eClinicalWorks).
• Experience handling denials, appeals, AR follow-ups, and compliance audits.
• Experience in outsourced medical billing operations or healthcare BPO.