We are seeking a Manager, Billing & Reimbursement to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Manager, Billing & Reimbursement plays a vital leadership role in overseeing the billing operations and reimbursement processes. This position ensures accurate and timely submission of provider claims, optimizing revenue cycle management while maintaining compliance with regulatory requirements. The Manager, Billing & Reimbursement collaborates closely with clinical, financial, and administrative teams to resolve billing discrepancies and improve reimbursement outcomes. They lead a team responsible for monitoring payer contracts, analyzing reimbursement trends, and implementing process improvements to enhance financial performance. Ultimately, this role drives the efficiency and effectiveness of provider billing functions to support the organization's financial health and patient service excellence.
Minimum Qualifications:
- Bachelor's degree in Healthcare Administration, Business, Finance, or a related field.
- Minimum of 5 years of experience in healthcare provider billing and reimbursement, including at least 2 years in a supervisory or management role.
- Strong knowledge of medical billing processes, CPT/HCPCS coding, and payer reimbursement methodologies.
- Familiarity with healthcare regulations such as HIPAA, Medicare, Medicaid, and commercial insurance requirements.
- Proficiency with electronic health record (EHR) systems and billing software.
- relevant experience may substitute for educational requirement on a year-for-year basis.
Preferred Qualifications:
- Master's degree in Healthcare Administration, Business, or a related discipline.
- Certification such as Certified Professional Biller (CPB) or Certified Revenue Cycle Professional (CRCP).
- Experience working with multiple payer contracts and complex reimbursement models.
- Demonstrated success in leading process improvement projects within a healthcare revenue cycle environment.
- Strong analytical skills with experience using data analytics tools to drive decision-making.
Responsibilities:
- Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
- Manage and supervise the daily operations of the provider billing and reimbursement team to ensure accurate and timely claim submissions.
- Develop and implement strategies to optimize reimbursement rates and reduce denials by analyzing payer contracts and reimbursement trends.
- Collaborate with clinical and administrative departments to resolve billing issues, discrepancies, and compliance concerns.
- Monitor regulatory changes and ensure billing practices adhere to federal, state, and payer-specific guidelines.
- Prepare and present regular reports on billing performance, reimbursement metrics, and process improvement initiatives to senior leadership.
- Train, mentor, and evaluate team members to maintain high standards of accuracy and productivity.
- Lead initiatives to streamline billing workflows and integrate new technologies or software to enhance operational efficiency.
- Performs other duties as assigned.