Senior Billing Manager

POSITION TITLE:
Senior Billing Manager

LOCATION:
Remote.

FLSA STATUS:
Exempt (administrative), determined under the FLSA and applicable state law. If the state salary threshold or duties test is not met, the position is non-exempt in that state.

REPORTS TO:
Director of Digital Solutions and Services

DOTTED LINE:
Controller (accounting for billed items)

SUPERVISORY RESPONSIBILITY:
None at hire; supervises billing staff as headcount grows.

DEPARTMENT:
Digital Solutions and Services

COMPENSATION: $95,000-$110,000 annually, plus optional medical/dental/vision insurance (partially employer-paid), 401(k), and incentive compensation opportunity.

The duties below under “Standards, Oversight, and Independent Judgment” and “Claim Execution and Follow‑Up” are essential functions under the ADA and applicable state law. This list is not exhaustive.

• Develop, maintain, and enforce SOPs, work instructions, payer playbooks, and billing edit rules; standardize workflows across all lines of business.
• Interpret LCDs, NCDs, coverage articles, payer policy, and fee schedule changes and how they apply to Company billing; set escalation, adjustment, and write-off criteria within delegated authority.
• Partner with Systems Development to define requirements, test releases, and refine billing, edit, and reporting logic in Venture’s digital tools.
• Track and report billing metrics — clean claim rate, first-pass yield, DSO, denial rate, appeal overturn rate, AR >90 days — by payer/line; set corrective action and remediation priorities.
• Build the billing function: define staffing plan, participate in hiring, develop training materials, and supervise billing staff as volume warrants.
• Serve as SME on billing across surgical dressings, institutional, and mobile wound care; provide direction, troubleshooting, and quality oversight to internal teams and partner providers.
• Comply with the Company’s Code of Conduct and compliance programs, complete assigned compliance/HIPAA training, and report suspected billing errors or compliance concerns through Company channels. The Company does not retaliate against good-faith reporting.

• Oversee, and as needed personally perform, preparation, scrubbing, and submission of clean claims across all lines through clearinghouse and payer portals.
• Work claims through adjudication: resolve front-end/clearinghouse rejections, correct and resubmit within SLA standards, and monitor status via CMS systems and payer portals.
• Own denial management end to end — identify root cause by payer, code, product, and provider; prepare corrected claims, reconsiderations, redeterminations, and higher‑level appeals with supporting clinical documentation.
• Apply accurate HCPCS/CPT coding, modifiers, revenue codes, units, and place of service; validate code-to-coverage alignment against LCDs/NCDs and payer policy before submission.
• Reconcile remittance advice, post payments/adjustments, and resolve underpayments, over payments, credit balances, and refunds; promptly escalating suspected over payments to Compliance and Finance to satisfy any report‑and‑return obligation.
• Manage AR and aging follow‑up; prioritize high‑dollar and at‑risk balances and elevate systemic payer issues to Finance and management.
• Coordinate with Reimbursement on IVR outcomes, prior authorization status, and documentation sufficiency; run insurance verification and submit authorizations as needed.
• Support responses to payer and government audits by assembling records packages and tracking outcomes.
• Maintain accurate, complete, compliant documentation in billing systems and CRM per HIPAA and company policy. Access PHI only as necessary (minimum necessary), and maintain a…