Billing Manager

Position: Division Billing Manager

Our company is a long-term care pharmacy serving patients across multiple states. With five locations and growing, we specialize in providing essential pharmaceutical services to long-term care facilities and skilled nursing facilities, ensuring patients receive the medications they need efficiently and accurately. With a commitment to excellence and innovation, we strive to improve patient outcomes and enhance the quality of care in the communities we serve. We are seeking a dynamic and experienced Divisional Billing Manager to oversee the billing operations for a designated locations within our long-term care pharmacy. The Divisional Billing Manager will be responsible for managing the billing team, ensuring accurate and timely claims submission, and optimizing revenue cycle management processes. This individual will play a critical role in driving revenue growth, maximizing reimbursement, and maintaining compliance with regulatory requirements.

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Predictable, reliable, and punctual attendance is an essential function of the job role.

• Lead and manage the billing team within the designated locations, providing guidance, support, and training to ensure high performance and productivity.
• Lead ongoing customer and facility performance reviews and make suggestions to improve billing metrics.
• Monitor key performance indicators (KPIs) and metrics related to billing and revenue cycle management, identifying trends, areas for improvement, and opportunities for optimization.
• Collaborate with internal stakeholders, including pharmacy operations, finance, and compliance, to streamline processes and resolve billing-related issues in a timely manner.
• Develop and implement strategies to minimize billing errors, denials, and rejections, and to maximize clean claim submission and first-pass resolution rates.
• Stay informed about changes in healthcare regulations, reimbursement policies, and industry trends affecting billing operations, and ensure compliance with all applicable laws and regulations.
• Establish and maintain strong relationships with payers, vendors, and other external partners to facilitate effective communication and resolution of billing-related issues.
• Conduct regular audits and quality assurance reviews of billing processes and documentation to ensure accuracy, completeness, and compliance with internal policies and external requirements.
• Prepare and present reports on billing performance, revenue trends, and financial metrics to senior management and other stakeholders, providing insights and recommendations for improvement.
• Foster a culture of continuous learning, innovation, and accountability within the billing team, promoting professional development and cross-functional collaboration.

PHYSICAL DEMANDS:

The physical demands and work environment described here are representative of those an employee encounters while performing the essential functions of this job. '

The regular work schedule for this position is approximately 40 hours per week (Monday-Friday) and may require additional hours/overtime as necessary. Must regularly lift and/or move up to 20 pounds. Specific vision abilities required by this job include: Close vision, Distance vision, Peripheral vision, Depth perception, Ability to adjust focus and Ability to match or detect differences between colors, including shades of color and brightness. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand, bend, and walk.

MINIMUM REQUIREMENTS:

Education & Experience: Bachelor's degree in healthcare administration, business, finance, or related field (Master's degree preferred). Minimum of 5 years of experience in healthcare billing, with at least 2 years in a supervisory or managerial role. Prior experience with formulary management, cost containment experience, and PPD (Prioritization, Planning, and Documentation) review, particularly in the insurance industry. Experience working in a long-term care pharmacy or similar healthcare setting preferred. RPH preferred.

Computer Skills: Experience with pharmacy billing software and revenue cycle management systems preferred. Experience with long term care pharmacy software preferred.

Language Skills: Excellent communication, leadership, and interpersonal skills. Ability to analyze data, identify trends, and make data-driven decisions. Ability to read and interpret documents such as medication documentation, business correspondence and procedure manuals; ability to write routine reports and business correspondence; ability to speak effectively, both in person and by telephone, to customers or employees of the organization.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; ability to compute rate, ratio, and percent and to draw and interpret bar graphs; ability to understand and interpret statistical reports, data charts and graphs.

Salary : $150,000 - $180,000