About the role
Overview Oversee day-to-day billing operations for research/clinical trials, transplant services, and client/corporate billing portfolios across HB and PB. Ensure accurate, compliant, and timely claim production and sponsor/client invoicing; minimize billing-driven denials and avoidable write-offs; accelerate cash and improve billing quality through standardized workflows, controls, and cross-functional collaboration.
Qualifications Education: Associate degree in Healthcare Administration, Healthcare Management, or a related field highly preferred.
Experience: Minimum of 3 to 4 years of progressive revenue cycle experience , including at least 1 to 2 years in billing operations (HB and/or PB) within a hospital or multi-site health system with a two-year degree.
- Minimum of 3 years of supervisory experience in hospital and/or professional billing operations.
- A formal degree may be substituted with 6+ years of direct, hands-on revenue cycle and supervisory experience.
- Demonstrated experience with Epic and revenue cycle technologies.
- Proven success leading teams through organizational change and process improvement initiatives.
- License/Certification/Registration: Not required.
- Deep expertise in:
- Hospital Billing (HB) and Professional Billing (PB)
- Research billing operations
- Transplant billing processes
- Client and corporate billing environments
- Working knowledge of:
- HIPAA compliance and privacy requirements
- Research billing audit practices
- Clinical trial billing regulations
- Transplant billing regulatory requirements
- Thorough understanding of:
- CMS and commercial payer billing regulations
- UB-04 and CMS-1500 claim forms
- NCCI edits
- Medically Unlikely Edits (MUEs)
- Local Coverage Determinations (LCDs)
- National Coverage Determinations (NCDs)
- Timely filing requirements and specialty case implications
- Research billing expertise, including:
- Sponsor billing
- Study budget management
- Billing grids
- Clinical trial compliance
- Investigational charge capture
- Sponsor invoicing and reconciliation
- Transplant billing expertise, including:
- Organ acquisition cost accounting
- DRG and bundling methodologies
- Transplant modifiers
- Coordination with Organ Procurement Organizations (OPOs)
- Client and corporate billing proficiency, including:
- Contract invoicing
- Third-party billing
- Departmental billing
- Special program billing
- Statement generation and reconciliation processes
- Strong ability to interpret and reconcile:
- Sponsor agreements
- Payer coverage determinations
- Institutional billing policies
- Billing responsibilities to prevent duplicate billing and ensure compliance
- Demonstrated change leadership and continuous improvement mindset, including experience implementing:
- Standardized playbooks
- Workflow optimization initiatives
- Automation solutions
- Excellent written and verbal communication skills.
- Strong cross-functional collaboration skills with the ability to work effectively across operational, clinical, research, financial, and compliance teams.
- Technical proficiency with:
- Epic and revenue cycle management (RCM) systems
- Research billing modules
- Work queue configuration
- Reporting and analytics tools
- Electronic sponsor invoicing platforms.
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