The Medical Billing & Claims Manager will lead and manage medical, pharmacy, and dental billing operations for third-party payers across outpatient, inpatient, ancillary, ambulatory surgery, and professional services. This role is responsible for ensuring properly executed claims are submitted timely, corrected claims are resubmitted as needed, reimbursement is maximized, denials are minimized, and Patient Financial Key Performance Indicators are monitored to support the Clean Claim Goal.
The position also provides technical direction, oversees billing staff, supports the Director of Revenue Cycle, and helps maintain compliance with payer rules, billing regulations, and internal policies.
Qualifications
- Associate’s degree in Business Administration or a related field, or equivalent experience.
- Minimum 3 years of successful supervisory or management experience.
- Minimum 5 years of experience as a medical billing technician in a tribal or non-profit healthcare patient accounting environment.
- Demonstrated knowledge of ICD-10 and CPT/HCPCS coding and billing procedures.
- Knowledge of UB-04, HCFA-1500, and ADA billing forms.
- Ability to interpret and resolve billing issues using system monitoring reports and related data.
- Strong computer skills and ability to work with multiple data systems.
- Ability to obtain HFMA Revenue Cycle Representative certification within 1 year of hire.
Additional skills
- Strong leadership, communication, organizational, and team-building skills.
- Ability to work under pressure, manage multiple priorities, and make effective decisions.
- Experience training staff, conducting evaluations, and supporting operational improvements.
- Familiarity with Medicare, Medicaid, managed care, commercial insurance, workers’ compensation, and motor vehicle insurance billing rules.
- Experience with charge master, EDI claims, medical billing systems, EHR, CCI edits, claims scrubbing, and insurance verification of benefits.
Location
Arizona, US
Employment Type
Full-time
Experience Level
Manager
Remote work allowed
No
Posted
1 month ago