Director, Billing Operations

About the role

Shield Healthcare is seeking a Director of Billing Operations to provide strategic, operational, and leadership oversight for the organization’s Billing Operations Department. This role ensures timely and accurate submission of claims, drives departmental performance, maintains compliance with payer and regulatory requirements, and supports organizational revenue and cash flow goals. The Director leads the team while collaborating cross-functionally with internal departments and external payers. This is an on-site position in Valencia, CA.

Responsibilities

• Direct all billing activities to ensure timely payment of claims.
• Establish, refine, and standardize workflows to maximize productivity, accuracy, and turnaround times.
• Ensure adherence to company policies, payer rules, and federal and state regulations.
• Serve as a liaison with Revenue Cycle, Billing, Coding, and Compliance departments, and external payers.
• Develop and execute short and long-term strategic plans for the Adjudication Department.
• Manage departmental budget, staffing models, and resource allocation.
• Monitor denial patterns and write-offs; implement corrective action plans.
• Lead, mentor, coach, and evaluate direct reports. Support direct reports in the development and performance management of the billing operations team.
• Conduct performance management actions as needed.
• Establish a 90-Day Onboarding plan to support new employees in their role.
• Oversee departmental training programs to ensure staff competency in billing, payer rules, and regulatory updates.
• Partner with Learning & Development team to build departmental training plans.
• Handle multiple priorities with aggressive deadlines, ensuring appropriate follow-up and closure.
• Complete special projects supporting claim management of payments with internal and external stakeholders as assigned, supporting team and organizational objectives and continuous improvement initiatives.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance or Accounting, or Health Information Management required; master’s degree preferred.
• 7+ years of experience in healthcare billing, adjudication, or revenue cycle operations.
• 4+ years of leadership experience managing large teams or multi-level departments.
• Proven ability to coach and mentor teams, identifying areas for team and individual development.
• Strong knowledge of payer rules, government programs, and medical billing regulations.
• Experience with healthcare billing/claims systems highly preferred.
• Proficiency in Microsoft 365 (Excel, PowerPoint, Word, SharePoint, Teams).
• Advanced or Expert level of proficiency in MS Excel.
• Strong analytical, organizational, and communication skills; able to explain analysis results to technical and non-technical teams.
• Able to work in a fast-paced, metric-driven environment, manage multiple priorities, meet deadlines, and respond to changing business needs.
• Excellent problem-solving and critical-thinking abilities.
• High attention to detail and accuracy.
• Strong collaboration skills with internal stakeholders.
• Ability to maintain patient confidentiality and comply with HIPAA regulations.

Pay

The posted range for this position is $130-160k annually plus a bonus opportunity. Many factors go into determining employee pay within the posted range, including education, prior experience, training, current skills, certifications, location/labor market, and internal equity.

Benefits

• Medical, Dental, and Vision
• 401(k) with Company Match
• Sick and Vacation Days
• Flexible Spending Account
• Life & Disability Insurance
• Education Assistance
• Employee Referral Program