Manager, Specialty Billing

Education: Associate degree in Healthcare Administration, Healthcare Management, or a related field highly preferred.

Experience: Minimum of 3 to 4 years of progressive revenue cycle experience, including at least 1 to 2 years in billing operations (HB and/or PB) within a hospital or multi-site health system with a two-year degree.

• Minimum of 3 years of supervisory experience in hospital and/or professional billing operations.

• A formal degree may be substituted with 6+ years of direct, hands-on revenue cycle and supervisory experience.

• Demonstrated experience with Epic and revenue cycle technologies.

• Proven success leading teams through organizational change and process improvement initiatives.

• License/Certification/Registration: Not required.

• Deep expertise in:

• Hospital Billing (HB) and Professional Billing (PB)
• Research billing operations
• Transplant billing processes
• Client and corporate billing environments

• Working knowledge of:

• HIPAA compliance and privacy requirements
• Research billing audit practices
• Clinical trial billing regulations
• Transplant billing regulatory requirements

• Thorough understanding of:

• CMS and commercial payer billing regulations
• UB-04 and CMS-1500 claim forms
• NCCI edits
• Medically Unlikely Edits (MUEs)
• Local Coverage Determinations (LCDs)
• National Coverage Determinations (NCDs)
• Timely filing requirements and specialty case implications

• Research billing expertise, including:

• Sponsor billing
• Study budget management
• Billing grids
• Clinical trial compliance
• Investigational charge capture
• Sponsor invoicing and reconciliation

• Transplant billing expertise, including:

• Organ acquisition cost accounting
• DRG and bundling methodologies
• Transplant modifiers
• Coordination with Organ Procurement Organizations (OPOs)

• Client and corporate billing proficiency, including:

• Contract invoicing
• Third-party billing
• Departmental billing
• Special program billing
• Statement generation and reconciliation processes

• Strong ability to interpret and reconcile:

• Sponsor agreements
• Payer coverage determinations
• Institutional billing policies
• Billing responsibilities to prevent duplicate billing and ensure compliance

• Demonstrated change leadership and continuous improvement mindset, including experience implementing:

• Standardized playbooks
• Workflow optimization initiatives
• Automation solutions

• Excellent written and verbal communication skills.

• Strong cross-functional collaboration skills with the ability to work effectively across operational, clinical, research, financial, and compliance teams.

• Technical proficiency with:

• Epic and revenue cycle management (RCM) systems
• Research billing modules
• Work queue configuration
• Reporting and analytics tools
• Electronic sponsor invoicing platforms.