Position Summary

The Medical Billing Manager is responsible for overseeing the day-to-day operations of the billing department, ensuring the accurate and timely submission of claims, optimal reimbursement, and full compliance with applicable regulations. This role is critical to the financial performance of the practice and requires in-depth experience with out-of-network billing, no-fault, and workers’ compensation claims—especially in the context of orthopedic and pain management services.

Key Responsibilities

Billing Operations

• Manage the full billing cycle from charge entry and claim submission to payment posting and denial management.

• Lead the billing process for out-of-network, no-fault, and workers’ compensation claims with an expert understanding of their complexities and unique documentation requirements.

• Monitor and maintain performance metrics including days in A/R, claim denial rates, and collections.

• Review EOBs, denials, and payer communications to ensure timely appeals and maximize revenue capture.

• Oversee patient statements, payment plans, and financial counseling in coordination with the front desk and finance teams.

Compliance and Documentation

• Ensure billing practices comply with federal/state regulations, HIPAA, and payer policies.

• Maintain up-to-date knowledge of ICD-10, CPT, and HCPCS codes, particularly as they relate to orthopedic and pain management procedures.

• Implement and monitor internal controls and billing audits to mitigate risks and ensure accuracy.

Leadership and Team Management

• Supervise, train, and evaluate billing team members to ensure optimal performance and adherence to best practices.

• Assign workloads, track productivity, and provide coaching for performance improvement.

• Facilitate ongoing education to adapt to payer changes and regulatory updates.

Cross-Department Collaboration

• Work closely with physicians, clinical staff, and administrative leaders to ensure correct documentation and coding.

• Act as the primary point of escalation for complex billing issues, both internally and with external vendors or payers.

Reporting and Analysis

• Generate monthly and ad-hoc reports on collections, aging, write-offs, and other key billing metrics.

• Provide insights and recommendations to leadership based on data analysis and industry trends.

• Support budgeting and forecasting with reliable revenue cycle inputs.

Required Qualifications

• Experience:

  • 3–5 years of progressive experience in medical billing, with at least 2 years in a supervisory or management capacity.

  • Preferred experience in out-of-network billing, no-fault, workers' compensation, and orthopedic or pain management practices.

• Technical Skills: Proficient with EMR/EHR and billing software and Microsoft Office Suite.

Desired Skills and Competencies

• In-depth knowledge of insurance guidelines (including Medicare, Medicaid, and commercial payers).

• Strong problem-solving and organizational skills.

• Excellent written and verbal communication abilities.

• Ability to work independently and collaboratively in a fast-paced clinical environment.

• Proven track record of improving billing workflows and increasing reimbursement efficiency.