Billing Ops Transform Lead

Role Summary

The Lead Billing Operations Analyst is a senior individual contributor responsible for leading complex billing and accounts receivable initiatives across Self-Funded, Third-Party Administrators, and Fully Insured (Group and Consumer) lines of business. This role combines deep operational expertise, technical reporting capabilities, and cross-functional leadership to resolve systemic billing issues, design scalable processes, and ensure financial accuracy across multiple billing platforms.

This position serves as a key liaison across Billing Operations, Technology, and Sales, driving alignment on high-impact issues and delivering solutions that improve accuracy, reduce risk, and enhance customer/member billing experience. The role requires strong analytical and technical capabilities, including the ability to independently develop reporting and insights using SQL and Microsoft Access.

Key Responsibilities

Process Design & Transformation

• Design and document end-to-end billing and AR processes, including future-state workflows and operating models
• Evaluate system capabilities and identify opportunities for automation, efficiency, and standardization
• Develop scalable approaches for complex scenarios including balance transfers, runout periods, and non-standard customer situations

Financial Reconciliation & Validation

• Perform in-depth reconciliations across customer accounts, invoices, and billing systems to ensure financial accuracy
• Validate alignment across platforms (e.g., billing systems, AR, and General Ledger)
• Ensure all billing adjustments, transfers, and write-offs are properly supported, accurate, and auditable

Technical Reporting & Data Analysis

• Design, develop, and maintain custom reports and data queries using SQL and Microsoft Access to support billing analysis and decision-making
• Extract, analyze, and interpret large data sets to identify discrepancies, trends, and root causes
• Provide data-driven insights to support issue resolution, operational improvements, and leadership reporting

Billing Issue Resolution & Solution Leadership

• Take the lead on complex, high-risk billing challenges, developing and implementing solutions across impacted systems and teams
• Conduct root cause analysis and define corrective actions to address systemic issues
• Partner cross-functionally to ensure solutions are executed effectively and sustained over time

Cross-Functional Leadership (No Direct Reports)

• Serve as a central point of coordination across Billing Operations, Accounting, Technology, Product, and Sales
• Lead working sessions to align on process changes, system enhancements, and financial treatments
• Influence outcomes and drive accountability across teams without formal authority

Stakeholder Communication & Mass Outreach

• Develop and deliver clear, concise communications to large stakeholder groups, including Sales, Account Management, and internal operational teams
• Create messaging related to billing issues, customer impacts, and upcoming changes
• Provide executive-level summaries of key issues, risks, and progress for leadership audiences

Billing Operations Oversight

• Provide subject matter expertise on complex billing scenarios, including:

• Balance transfers and on-account management

• Claims invoice adjustments and retro billing

• Final settlement processing for terminated or migrated accounts

• Support high-visibility billing events to ensure accuracy, timeliness, and appropriate stakeholder alignment

Controls & Continuous Improvement

• Identify gaps in billing processes and controls and partner to implement improvements
• Support audit readiness through documentation, validation processes, and control enhancements
• Contribute to enterprise initiatives focused on billing transformation and operational excellence

Qualifications

Education

• Bachelor's degree in business administration, Business Management, or a related field
• In lieu of a degree, 7+ years of experience in project management, consulting, or healthcare insurance

Experience

• 7-10+ years of experience in billing operations, accounts receivable, finance, or healthcare administration
• Demonstrated experience leading complex billing issue resolution and cross-functional initiatives
• Experience in healthcare or insurance billing environments strongly preferred
• Experience with system implementations, migrations, or process transformation efforts

Technical Skills

• Strong proficiency in SQL and Microsoft Access for reporting and data analysis

• Advanced Excel skills (data analysis, reconciliation, and modeling)

• Strong understanding of:

• Billing and AR processes

• Financial reconciliation and GL alignment

• Claims-based billing environments

• Experience working with enterprise billing platforms (e.g., CABS, enGen, NextGen or similar systems)

Core Competencies

• Analytical Expertise: Ability to work with large, complex datasets and deliver actionable insights
• Problem Solving: Proven ability to lead resolution of complex operational issues
• Process Design: Strong capability to design and improve scalable workflows
• Influence Without Authority: Ability to drive outcomes across multiple teams
• Communication: Skilled in developing both executive-level communications and broad stakeholder messaging
• Attention to Detail: High degree of accuracy, control awareness, and audit readiness focus