Director of Billing

Job Description

Job Description

Position Summary

The Billing Manager is responsible for leading the daily operations of the medical billing department to ensure timely claim submission, accurate reimbursement, regulatory compliance, and exceptional customer service. This position oversees billing personnel, monitors revenue cycle performance, identifies process improvements, and collaborates with clinical, administrative, and financial teams to optimize reimbursement and operational efficiency.

Reporting Structure

Reports to: Executive Leadership (CEO, CFO, and Physician Leadership)

Supervises: Medical Billing Team

Essential Responsibilities

Department Leadership

• Manage and oversee the daily activities of the billing department.
• Supervise, coach, and develop billing staff to ensure high performance and accountability.
• Conduct employee evaluations, manage scheduling, approve paid time off, and address performance concerns.
• Promote a collaborative, productive, and customer-focused work environment.

Revenue Cycle Management

• Monitor Accounts Receivable (A/R) performance and aging reports to identify trends and opportunities for improvement.
• Review outstanding balances and coordinate follow-up activities to improve collections.
• Ensure accurate billing, payment posting, contractual adjustments, and account reconciliation.
• Oversee rejected, denied, and unpaid claims by identifying root causes, correcting errors, and ensuring timely resubmission.
• Review patient balances, collection accounts, refunds, credit balances, and overpayments for accuracy and resolution.
• Analyze Explanation of Benefits (EOBs) to verify reimbursement accuracy and payment integrity.

Billing Operations

• Investigate billing discrepancies involving charges, payments, adjustments, and insurance claims.
• Maintain fee schedules, payer information, procedure codes, provider records, and billing system data.
• Support electronic claims processing, remittance enrollment, eligibility services, and clearinghouse functions.
• Coordinate with practice management and billing software vendors regarding updates, system enhancements, and issue resolution.
• Assist with credentialing documentation and payer enrollment requests when needed.

Process Improvement & Compliance

• Evaluate billing workflows and implement improvements that increase efficiency, reduce denials, and improve reimbursement.
• Monitor payer policy changes, coding updates, and reimbursement guidelines while communicating necessary changes to physicians and staff.
• Develop and maintain billing policies and standard operating procedures that promote compliance with federal, state, and payer regulations.
• Collaborate with clinical and front-office staff to improve documentation quality, insurance verification, referrals, authorizations, and other processes affecting reimbursement.
• Maintain productive relationships with insurance representatives to resolve complex payment issues.

Patient & Vendor Relations

• Resolve escalated patient billing concerns with professionalism and empathy.
• Work with vendors, software providers, clearinghouses, and medical supply representatives regarding billing updates, coding changes, and operational support.

Reporting & Financial Analysis

• Prepare recurring and ad hoc financial, billing, coding, and operational reports for executive leadership and physicians.
• Analyze revenue cycle metrics and provide recommendations to improve financial performance.
• Review monthly adjustment reports, aging reports, reimbursement trends, and staff productivity metrics.
• Assign follow-up activities for aged claims and unresolved accounts.

Month-End Responsibilities

• Verify billing accuracy before closing each monthly billing cycle.
• Complete month-end billing close procedures.
• Generate monthly revenue cycle reports and summarize financial trends for leadership.
• Review adjustment reports and assign follow-up on outstanding claims.

Quarterly Responsibilities

• Prepare quarterly revenue cycle and financial performance reports.
• Analyze reimbursement trends, payer performance, and operational metrics.
• Complete required system uploads and reporting activities.

Annual Responsibilities

• Coordinate annual coding and reimbursement updates, including ICD-10, CPT, and HCPCS revisions.
• Ensure fee schedules and payer information remain current.
• Assist with implementation of Medicare and commercial payer policy changes.
• Participate in continuing education related to medical billing, coding, and compliance.

Additional Responsibilities

• Provide support for basic billing system and office technology issues when appropriate.
• Participate in special projects and strategic initiatives assigned by executive leadership.
• Perform other duties as assigned.

Qualifications

Education

• High school diploma or equivalent required.
• Associate's degree or additional post-secondary education preferred.
• Certified Professional Coder (CPC) or equivalent certification preferred.

Experience

• Minimum of five (5) years of progressive medical billing and revenue cycle experience.
• At least one (1) year of leadership or supervisory experience preferred.
• Experience within a physician practice or specialty healthcare environment preferred.
• Orthopedic billing experience is a plus.

Knowledge

• Medical billing, coding, collections, and revenue cycle management.
• Commercial insurance, Medicare, Medicaid, and payer reimbursement practices.
• Medical terminology, CPT, ICD-10, and HCPCS coding.
• Healthcare compliance and regulatory requirements.
• Financial reporting, data analysis, and performance metrics.
• Practice management and electronic health record (EHR) systems.

Skills

• Leadership and staff development.
• Strong analytical and problem-solving abilities.
• Excellent organizational and time management skills.
• Effective verbal and written communication.
• Customer service and conflict resolution.
• Intermediate to advanced Microsoft Office proficiency, particularly Excel.
• Ability to manage multiple priorities while meeting deadlines.

Abilities

• Build effective working relationships with physicians, staff, vendors, patients, and insurance representatives.
• Interpret billing policies, payer guidelines, and organizational procedures.
• Analyze financial and operational data to identify improvement opportunities.
• Exercise sound judgment while handling confidential information.
• Work independently and collaboratively in a fast-paced healthcare environment.
• Adapt to changing regulations, technology, and organizational priorities.

Work Environment

This position is primarily based in a professional medical office setting. The role requires prolonged periods of sitting and frequent computer use. Occasional standing, bending, lifting office materials, and walking throughout the facility may be required. Periodic evening or weekend work may be necessary to meet operational deadlines.

Physical Requirements

• Prolonged sitting and computer work.
• Frequent use of hands and fingers for keyboard and office equipment operation.
• Ability to occasionally bend, reach, stoop, and lift office materials.
• Ability to maintain focus while managing multiple priorities and time-sensitive deadlines.
• Capable of performing the essential functions of the position with or without reasonable accommodation.