Billing Manager

Billing Manager – Leading Edge Administrators

Job Summary:

The Billing Manager is responsible for leading and optimizing the full billing cycle functions within a Third-Party Administration (TPA) environment. This role oversees day‑to‑day billing operations, ensures accuracy in claims and premium invoicing, and drives continuous improvements to maximize revenue integrity and cash flow. The Billing Manager will manage, train, and develop the billing team while ensuring alignment with payer rules, client contractual requirements, and regulatory standards.

• Manage billing staff and prepare/review bills to ensure accuracy and high-quality work products that are following regulatory agency guidelines.
• Oversee preparation, review, and submission of claims/premium invoices, ensuring compliance with payer guidelines, benefit plan provisions, and applicable regulations.
• Manage the auditing of billing data, account adjustments, aging, and reconciliation activities and identify variances or errors and drive corrective actions accordingly.
• Serve as a subject matter expert for billing practices, coding accuracy, and payer adjudication requirements.
• Monitor key performance indicators (KPIs) such as accounts billing error rate, reasons for corrections made, receivable days, denial rates, and collection targets.
• Partner with internal departments, payer partners, clients, and external vendors to troubleshoot billing issues and support seamless integration of billing processes.
• Efficiently manage expenses of the department adhering to Finance guidelines.
• Ensure that all billing practices comply with federal, state, and local regulations, as well as insurance company guidelines.
• Oversee team adherence to documented billing workflows, SOPs, and internal controls.
• Lead audits, client reporting obligations, and communications with the clients.
• Manage and direct the resolution of complex billing functions and escalations, coordinating resources and decision‑making to remove barriers.

• Bachelor’s degree in Business, Accounting, Finance, Healthcare Administration, or related field or equivalent experience required.
• 4+ years of billing experience, preferably within a TPA, health insurance, or healthcare revenue cycle setting.
• Certified Professional Biller (CPB), Certified Review Cycle Professional (CRCP) or similar credential preferred.
• Advanced knowledge of MS Excel including manipulation of large datasets, complex formulas and macros, pivot tables and Power Query.
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint.
• Expert keyboard and navigation skills and ability to learn new programs.
• Communicate clearly and professionally with internal and external customers.
• Work effectively individually and as part of a team to achieve established outcomes. Understand others’ roles and empower one another to take responsibility to be successful.
• Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers.
• Pay close attention to detail in all aspects of the job.
• Make decisions using available resources and sound judgment.
• Maintain confidentiality and discretion.
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively.
• Teach, coach, and counsel associates by effectively communicating and providing follow‑up.
• Open to others’ ideas and exhibits willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events.
• Follow instructions, respond to direction, and solicit feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.

• Constant:
  Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office.
• Occasional:
  Lift and/or move up to 10 pounds.
• Occasional:
  Abili…