The Billing Manager owns the front-end and cash-application integrity of the revenue cycle for our multi-state ambulatory infusion center (AIC) operation — clean claim creation, accurate charge capture on high-dollar specialty drug claims (POS 11), reconciled payment posting, and the operational health of all EDI transactions through the clearinghouse. Partners with the AR & Denials Manager, Patient Access, Coding, and IT to drive cash velocity and minimize denials at the front door. This role is distinct from claims follow-up and denials management, which are owned by a separate manager.
• Own day-to-day clearinghouse operations (Waystar) and EDI transaction sets (837P, 835 ERA, 270/271, 276/277, 277CA/999); resolve rejections within 24 business hours; manage payer ID mapping, EDI/ERA enrollment, and re-enrollment across all payers and TINs.
• Maintain configuration parity between AdvancedMD and Waystar (scrubber rules, custom edits, payer-specific routing); serve as operational owner for clearinghouse transitions, payer consolidations (e.g., Z1274 PPOONE), and TIN consolidations.
• Supervise charge entry across all AIC sites; enforce NDC/HCPCS dual-reporting, JW modifier, weight-based unit calculation, POS 11 coding; maintain SOPs for high-risk drug classes (specialty biologics, IVIG, biosimilars, monoclonal antibodies); conduct routine charge audits.
• Supervise ERA auto-posting, manual EOB posting, patient payment posting, and reconciliation to bank deposits/lockbox; ensure daily, monthly, and year-end cash close on schedule with unposted cash <2% over 1 business day; govern recoupments, takebacks, refunds, copay assistance, and grant payments.
• Own contractual adjustment accuracy at posting; identify underpayments vs. expected fee schedules and route variances to AR & Denials; maintain controls over remits arriving outside the ERA stream (paper EOBs, payer portals, TPAs).
• Partner with Intake and Clinics to close upstream gaps driving charge errors; hire, train, coach, and performance-manage the team across multiple states; maintain a KPI scorecard; develop SOPs and onboarding curriculum; partner with IT on automation/RPA opportunities.
• Experience: Minimum 7+ years of progressive healthcare revenue cycle experience with at least 2 years of prior supervisory experience over charge entry, payment posting, and/or EDI.
• Technical: Strong working knowledge of 837P/835 transaction sets, clearinghouse operations, payer EDI enrollment, HCPCS/CPT/ICD-10, NDC reporting, NCCI edits, and modifiers relevant to drug administration and infusion billing.
• Skills: Multi-state, multi-payer experience (commercial, Medicare, MA, Medicaid); strong analytics on KPI dashboards, aging reports, and remittance trends; excellent written/verbal communication for executive-level reporting.
Preferred stack: AdvancedMD (PM), WeInfuse / R2 (infusion workflow), Waystar (clearinghouse), Microsoft Excel & Office Suite. Experience with comparable systems plus demonstrated rapid-learning ability will be considered.
• Direct experience in ambulatory infusion (AIC), specialty pharmacy, oncology infusion, rheumatology, or other office-based infusion environments.
• Hands-on Waystar experience (scrubber rule configuration, EDI enrollment, ERA/835 setup, rejection workflow management).
• Merger / TIN consolidation experience, 120-day payer notice management, EDI re-enrollment under successor TINs, ERA re-mapping, clean cutover between legacy and successor entities.
• Certification such as AAHAM, CRCR, or equivalent revenue cycle–related credential
Clean claim rate: 97% | First-pass acceptance rate: 95% |
Charge lag (DOS to submission): 5 business days | ERA auto-post rate: 90% of ERA dollars |
Unposted cash >5 days: <2% of monthly cash | Charge entry / posting QA accuracy: 98% / 99% |
EDI rejection turnaround: 24 business hours | Month-end cash close on schedule: 100% |