Billing Manager Certified Professional Coder (CPC)

Job Summary

Billing Manager (CPC)

Key Responsibilities

• Team Leadership & Supervision:

• Manage daily operations of the billing, coding, and accounts receivable teams.
• Assign workload, monitor performance, and provide training and development to staff.
• Conduct regular team meetings to communicate updates on payer policies, coding changes, and performance goals.

• Billing & Coding Oversight:

• Ensure accurate and compliant coding according to CPT, ICD-10, and HCPCS standards.
• Review complex claims for coding accuracy and payer compliance prior to submission.
• Monitor and correct billing errors, charge entry discrepancies, and claim rejections.

• Revenue Cycle Management:

• Oversee the full billing cycle from charge capture to payment posting and denial management.
• Analyze aging reports and AR metrics to identify bottlenecks and drive collections performance.
• Ensure timely claim submission and appeals to meet payer filing deadlines.

• Compliance & Audit:

• Maintain compliance with HIPAA, CMS, and payer-specific regulations.
• Conduct periodic internal audits of coding and billing to ensure accuracy and compliance.
• Prepare documentation for external audits and implement corrective action plans.

• Reporting & Analytics:

• Generate reports on billing productivity, denial trends, collection rates, and revenue performance.
• Present financial and operational metrics to leadership for strategic decision-making.
• Identify and implement process improvements to increase efficiency and reduce denials.

• Cross-Department Collaboration:

• Work closely with providers, coders, and finance teams to resolve documentation or coding issues.
• Partner with payers to clarify claim requirements and resolve recurring issues.

Required Qualifications

• Education:

• Bachelors degree in Healthcare Administration, Finance, Business, or related field (or equivalent experience).

• Certification:

• Certified Professional Coder (CPC)

  required (AAPC).
• Additional certifications such as CPB, COC, or CCS are a plus.

• Experience:

• 5+ years of progressive experience in medical billing and coding.
• 2+ years in a leadership or supervisory role within RCM operations.
• In-depth knowledge of payer reimbursement methodologies, including Medicare, Medicaid, and commercial payers.

• Skills:

• Strong analytical and problem-solving abilities.
• Excellent communication and leadership skills.
• Proficiency in RCM software (e.g., Epic, Athenahealth, eClinicalWorks, NextGen, AdvancedMD, or similar).
• Advanced Excel and reporting skills.

Performance Metrics

• Accuracy rate in claim submission and coding
• Reduction in claim denials and rejections
• Days in Accounts Receivable (A/R)
• Compliance audit results