AR Manager | Medicare

About the role

The Billing Operations & Medicare AR Manager oversees Hospital Billing (HB) and Professional Billing (PB) billing operations, manages Medicare Accounts Receivable (AR) activities, and leads billing and Medicare AR teams.

Responsibilities

• Manage day-to-day Hospital Billing (HB) and Professional Billing (PB) billing operations
• Oversee claim generation, claim validation, and claim submission processes
• Monitor and resolve billing edits, front-end claim rejections, and payer submission issues
• Manage Medicare Direct Data Entry (DDE) activities, including claim corrections, status reviews, RTP (Return to Provider) claims, and billing issue resolution
• Ensure claims are submitted accurately and within established filing deadline
• Develop and implement processes to improve clean claim rates and reduce avoidable rework
• Maintain billing work queues and productivity standards
• Coordinate with Coding, Revenue Integrity, Patient Financial Services, and Clinical departments to resolve billing-related issues
• Ensure compliance with Medicare, Medicaid, and commercial payer billing requirements
• Lead Medicare Accounts Receivable (AR) management, focusing on reducing aging, resolving reimbursement issues, recovering underpayments, and improving overall collection performance
• Oversee Medicare AR follow-up activities for both HB and PB accounts
• Monitor Medicare aging inventories and prioritize collection efforts
• Manage resolution of unpaid, partially paid, and denied Medicare claims
• Review and resolve RTP claims, denials, underpayments, medical necessity issues, coverage-related denials, and billing-related reimbursement delays
• Identify denial and AR trends and implement corrective action plans
• Work closely with billing teams to address root causes impacting Medicare reimbursement

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field
• Equivalent combination of education and experience may be considered
• 5+ years of experience in healthcare billing operations
• 3+ years of leadership experience managing billing and/or accounts receivable teams
• Extensive experience with both Hospital Billing (HB) and Professional Billing (PB) operations
• Strong Medicare billing and AR management experience
• Experience working with Medicare DDE
• Comprehensive understanding of Medicare billing regulations, DDE processes, claim edits and rejections, hospital billing (HB), professional billing (PB), Medicare AR follow-up and collections, as well as denial management and appeals
• Knowledge of UB-04 and CMS-1500 claim processing
• Strong analytical and problem-solving skills
• Experience with Epic Resolute HB/PB
• Excellent communication and leadership abilities