Job Summary
We are seeking a senior Medical Billing Manager leader to oversee AR operations, audit programs, and automation initiatives across a high-volume healthcare billing environment (~100,000 transaction lines annually). This role manages a team of approximately 15 AR and billing professionals and is responsible for improving cash performance, reducing denials, strengthening controls, and building scalable audit and analytics systems.
This position requires strong healthcare revenue cycle expertise, leadership experience, and the ability to use data, automation, and scripting tools (including AI-assisted development) to improve accuracy and efficiency.
Key Responsibilities
- Lead daily AR operations including claims follow-up, denials, underpayments, payment posting, reconciliations, refunds, and patient AR (as applicable)
- Manage, coach, and develop a team of ~15 AR and billing staff
- Set performance goals and manage workflows using KPIs and productivity metrics
- Create and maintain SOPs, escalation paths, and payer follow-up standards
- Design and manage a large-scale AR audit program (sampling, controls, exception logic, and audit calendar)
- Audit claim status, payer responses, posting accuracy, adjustments, write-offs, refunds, and recoupments
- Identify root causes of errors and implement corrective actions to prevent recurrence
- Oversee denial and underpayment management, including trend and root-cause analysis
- Develop payer-specific follow-up and escalation playbooks
- Partner with operations, coding, authorizations, and intake teams to reduce upstream billing issues
- Build and maintain audit and automation tools using modern data and scripting methods (e.g., Excel, SQL, Python)
- Use IDE-based editors and AI tools to:
- Reconcile payments and ERAs to claims
- Detect leakage, posting errors, and anomalies
- Flag aging, denial, and adjustment issues
- Generate worklists and audit queues
- Drive system and workflow improvements within billing and EHR platforms, especially for behavioral health billing
- Ensure adherence to payer rules and internal controls
- Maintain audit documentation and defensible processes
- Support finance with month-end close, AR reconciliation, and executive reporting
Required Qualifications
- 5+ years of healthcare medical billing / AR experience
- 2+ years in a lead or supervisory role
- Strong experience with AR follow-up, denials, payment posting, reconciliations, and payer escalation
- Proven audit and controls experience in high-volume environments
- Strong technical skills, including:
- Advanced Excel or Google Sheets
- Working with large datasets
- SQL and/or Python for analysis or automation
- Comfort using IDEs and AI-assisted tools
Preferred Qualifications
- Behavioral health billing experience
- Experience with authorizations, medical necessity requirements, and program-based billing
- Familiarity with EDI/ERA workflows, clearinghouses, and payer portals
- Experience building dashboards, audit tools, or analytics systems
- Bachelor’s degree in finance, accounting, healthcare administration, or equivalent experience
Job Type: Full-time
Pay: From $65,000.00 per year
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Ability to Relocate:
- Saint George, UT 84770: Relocate before starting work (Required)
Work Location: In person
