Manager, Specialty Billing

Overview

Oversee day-to-day billing operations for research/clinical trials, transplant services, and client/corporate billing portfolios across HB and PB. Ensure accurate, compliant, and timely claim production and sponsor/client invoicing; minimize billing-driven denials and avoidable write-offs; accelerate cash and improve billing quality through standardized workflows, controls, and cross-functional collaboration.

Oversee day-to-day billing operations for research/clinical trials, transplant services, and client/corporate billing portfolios across HB and PB. Ensure accurate, compliant, and timely claim production and sponsor/client invoicing; minimize billing-driven denials and avoidable write-offs; accelerate cash and improve billing quality through standardized workflows, controls, and cross-functional collaboration.

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.