About the role
Overview Lead underpayment and variance resolution for Hospital (HB) and Professional (PB) claims. Drive recovery of underpayments, resolution of payment variances, payer negotiations, and process improvements to maximize net revenue and reduce rework and aging.
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.
- Strong analytical and problem-solving skills, including the ability to:
- Conduct root-cause analysis
- Identify trends and operational issues
- Develop and present actionable recommendations
- Drive data-informed improvements
- Strong knowledge of:
- Payer adjudication practices
- CPT and ICD coding impacts on reimbursement and denials
- Contract terms and payer agreements
- Clinical documentation requirements and their influence on payments
- Proven leadership, coaching, and performance management capabilities.
- Proficiency with:
- Reporting and analytics tools
- Microsoft Excel
- Data analysis and interpretation
- Data-driven decision making
- Excellent communication and stakeholder management skills, with the ability to collaborate effectively across:
- Clinical teams
- Financial operations
- Information Technology (IT) departments
- Revenue cycle stakeholders
- High attention to detail, integrity, and professionalism.
- Demonstrated commitment to:
- Regulatory compliance
- Audit readiness
- Operational accuracy
- Continuous process improvement and quality outcomes.
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