Director of Billing

Director of Billing

The Director of Billing at Heart Share Human Services is responsible for leading and optimizing all aspects of predominantly Medicaid billing and overall revenue cycle performance across the organization, ensuring timely and accurate claim submission, maximizing reimbursement, and maintaining compliance with all federal and state Medicaid regulations. This role oversees a data-driven billing operation, leveraging analytics, key performance indicators (KPIs), and system reporting to monitor productivity, denial trends, reimbursement rates, and accounts receivable performance, while driving continuous improvement through the use of technology, including the Millin billing platform, and implementation of best practices that enhance efficiency, accuracy, and financial outcomes.

The Director partners closely with Fiscal, Program Operations, and Compliance teams to ensure billing integrity, strengthen internal controls, and support strategic decision-making related to revenue generation and regulatory compliance.

Essential Functions and Primary Responsibilities of Position:

Revenue Cycle Oversight

• Lead and manage the full Medicaid revenue cycle, including claim submission, rebilling, payment posting, denial management, and accounts receivable reconciliation.
• Ensure timely claim submission and reimbursement optimization across all Medicaid-funded programs and other non-Medicaid programs (e.g., private pay, ISS).
• Monitor aging accounts receivable and implement strategies to maintain optimal collection timelines.

Data Analytics and KPI Management

• Develop and monitor KPIs for billing operations, including:
• Clean claim rate
• Days in accounts receivable
• Denial rates and root cause trends
• Claims submission timeliness
• Reimbursement cycle times
• Billing productivity metrics
• Utilize the Millin system reporting and data analytics tools to analyze billing performance and identify opportunities for revenue improvement.
• Produce regular billing analytics reports and dashboards for Fiscal leadership, highlighting operational trends, revenue performance, and risk areas.

Team Leadership and Operational Management

• Lead, mentor, and supervise the billing team to ensure high performance, accuracy, and accountability.
• Establish performance expectations and productivity metrics for billing staff.
• Support professional development and cross-training to strengthen team capacity and operational resilience.

Compliance and Regulatory Oversight

• Ensure compliance with all Medicaid regulations, billing policies, and payer requirements.
• Oversee internal billing audits and coordinate preparation for external Medicaid or regulatory audits.
• Maintain up-to-date knowledge of Medicaid regulatory changes and reimbursement guidelines.

Process Improvement and Systems Optimization

• Evaluate billing workflows and implement process improvements to reduce errors, increase automation, and improve reimbursement turnaround.
• Collaborate with IT and Fiscal to optimize use of the Millin billing system, including reporting functionality and workflow configuration.
• Identify opportunities for system enhancements, data integrity improvements, and operational efficiencies.

Cross-Functional Collaboration

• Partner with program leadership, clinical teams, and fiscal staff to resolve billing issues and strengthen documentation processes that support compliant billing.
• Serve as the primary liaison with Medicaid representatives and external partners related to billing and reimbursement matters.

• Bachelor's degree in Accounting, Finance, Healthcare Administration, or a related field required.

• Minimum 7–10 years of healthcare or human services billing experience, including at least 3–5 years in a leadership position overseeing Medicaid billing operations.

• Demonstrated experience managing billing operations using Millin or comparable Medicaid billing and revenue cycle platforms.

• Advanced Excel skills experience required (e.g., VLookup, Pivot Table).

• Strong experience developing and monitoring billing key performance indicators (KPIs), operational dashboards, and performance metrics.

• Advanced knowledge of Medicaid billing regulations, claim submission protocols, rate structures, and payer requirements.

• Proven ability to analyze billing data to identify revenue unaccounted loss of income due to under billing, unbilled, errors, denial trends, and process improvement opportunities.

• Strong analytical, leadership, and communication skills with the ability to translate complex billing data into…