Manager, Billing - Home Medical Equipment

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent required.

EXPERIENCE:

1. Minimum of 5 years of experience in billing and revenue cycle management,

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's degree in Healthcare Administration, Business, Finance, or related field

EXPERIENCE:

1. Previous experience in Medical Equipment or healthcare services

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Provide leadership and oversight for daily billing and revenue cycle operations within the Home Medical Equipment (HME) department under WVUHS Home Care

2. Manage Accounts Receivable (A/R) to ensure timely payments and resolve outstanding balances.

3. Oversee the denial management process, including identifying trends, addressing root causes, and working to reduce denials through corrective action and process improvement.

4. Handle Work in Progress (WIP) corrections to ensure accurate and timely submission of claims and payments.

5. Conduct regular audits of billing processes, ensuring compliance with all regulatory and healthcare requirements, and identify areas for improvement.

6. Manage billing for special products and services, ensuring proper coding, pricing, and documentation.

7. Oversee customer service queues, ensuring that inquiries and issues related to billing and revenue cycle are resolved in a timely and professional manner.

8. Collaborate with insurance companies, providers, and internal teams to ensure accurate claims submission and reimbursement.

9. Monitor revenue cycle performance metrics, report findings, and implement strategies to improve efficiency and financial outcomes.

10. Develop and maintain training materials and provide ongoing education to the billing team to ensure accurate coding, compliance, and customer service.

11. Review and process claim adjustments, rejections, and appeals as necessary, ensuring that proper documentation is in place.

12. Maintain up-to-date knowledge of billing regulations, payer requirements, and industry trends to ensure compliance and maximize reimbursement.

13. Work closely with WVUHS leadership to align billing processes with overall departmental goals and optimize revenue cycle operations.

14. Oversee cash posting processes, ensuring accurate and timely posting of payments from patients, insurance providers, and other sources to the appropriate accounts.

15. Ensure payments are applied correctly to accounts receivable and resolve discrepancies related to cash postings

16. Serves as the primary liaison for the third-party billing vendor, overseeing day to day operations and managing the partnership to ensure optimal performance and positive business outcomes.

17. Driving overall revenue cycle performance by setting objectives, establishing KPIs, and monitoring metrics to ensure timely and accurate claims submissions, accounts receivable management, and denial resolution.

18. Leading efforts to identify, implement, and evaluate process improvement initiatives to enhance billing workflows and maximize reimbursement opportunities.

19. Designing and overseeing a robust audit program to identify and mitigate risks while maintaining regulatory compliance and accuracy in billing practices.

20. Mentoring and developing the billing team by providing continuous training, fostering professional growth, and promoting a culture of excellence and accountability.

21. Analyzing financial and operational data to provide actionable insights to leadership, enabling informed decision-making and strategic planning.

SKILLS AND ABILITIES:

1. Excellent communication skills, both written and verbal, to effectively interact with internal teams, patients, and external partners.

2. Strong knowledge of healthcare billing regulations, insurance claims, coding, and reimbursement processes.

3. Proficient in data analysis, revenue cycle metrics, and performance reporting.

4. Excellent problem-solving, organizational, and decision-making skills.

5. Ability to work independently with minimal supervision while managing multiple tasks and deadlines

6. This role requires strong leadership and strategic thinking skills to oversee complex revenue cycle operations.

7. Key competencies include expertise in healthcare billing and compliance regulations, proficiency in data analysis and performance metrics, and the ability to lead process improvement initiatives.

8. Exceptional communication and collaboration skills are essential to drive cross-functional teamwork and maintain effective relationships with payers, internal teams, and external stakeholders.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.