RCM Billing Manager

The Billing Manager owns the front‑end and cash‑application integrity of the revenue cycle for our multi‑state ambulatory infusion center (AIC) operation — clean claim creation, accurate charge capture on high‑dollar specialty drug claims (POS 11), reconciled payment posting, and the operational health of all EDI transactions through the clearinghouse. Partners with the AR & Denials Manager, Patient Access, Coding, and IT to drive cash velocity and minimize denials at the front door.

This role is distinct from claims follow‑up and denials management, which are owned by a separate manager.

• Own day‑to‑day clearinghouse operations (Waystar) and EDI transaction sets (837P, 835 ERA, 270/271, 276/277, 277CA/999); resolve rejections within 24 business hours; manage payer , EDI/ERA enrollment, and re‑enrollment across all payers and TINs.
• Maintain configuration parity between AdvancedMD and Waystar (scrubber rules, custom edits, payer‑specific routing); serve as operational owner for clearinghouse transitions, payer consolidations (e.g., Z1274 → PPOONE), and TIN consolidations.
• Supervise charge entry across all AIC sites; enforce NDC/HCPCS dual‑reporting, JW modifier, weight‑based unit calculation, POS 11 coding; maintain SOPs for high‑risk drug classes (specialty biologics, IVIG, biosimilars, monoclonal antibodies); conduct routine charge audits.
• Supervise ERA auto‑posting, manual EOB posting, patient payment posting, and reconciliation to bank deposits/lockbox; ensure daily, monthly, and year‑end cash close on schedule with unposted cash 5 days: