Manager, Revenue Cycle Business Services PB in Allen, Texas at TEXASCONNECT INC

The Manager of Revenue Cycle Business Services (Professional Billing “PB”) is responsible for the day-to-day leadership of the professional (physician) billing and account follow-up teams, ensuring claims are billed accurately and timely and that unresolved accounts are driven to resolution. This role owns front-line operational performance across the pre-submission (charge review, claim edit and billing) and post-submission (no-response, rejections, denials, and underpayment follow-up) phases of the hospital’s revenue cycle. The successful candidate combines hands-on Epic Resolute Professional Billing expertise with strong people leadership, deep working knowledge of payor policies (including CMS/Medicare and Medicaid guidelines and coordination of benefits), and sound analytical judgement to remove barriers, improve processes, and move accounts to resolution.

SPECIFIC SKILLS NEEDED

• Strong, hands-on experience with Epic Resolute Professional Billing (PB), including claim edit, follow-up, and credit work queues, with the ability to navigate liability buckets, claim status insights, and follow-up activities
• Working knowledge of professional (CMS-1500/837P) claim requirements, CPT/HCPCS/ICD-10 coding, modifiers, place of service, fee schedules, and professional reimbursement methodologies
• Working knowledge of CMS billing and reimbursement rules (Medicare and Medicaid) and commercial payor requirements, including timely filing and appeal rights
• Working knowledge of coordination of benefits (COB) rules and primary/secondary payor determination
• Experience with clearinghouse tools and payor portals for claim status research, rejection resolution, and appeal submission
• Strong critical thinking and analytical skills, with a proven ability to identify root causes and move accounts and claims to resolution
• Ability to monitor team performance and manage workflows and productivity to optimize efficiency, quality, and outcomes
• Demonstrated ability to manage to KPIs and communicate performance results to leadership
• Excellent leadership, coaching, and communication skills
• Proficient in Microsoft Excel for reporting and analysis

EDUCATION/EXPERIENCE/TRAINING
Required:
• Bachelor's degree in healthcare administration, business, finance, or related field, or equivalent combination of education and experience
• 5+ years of hospital (institutional) billing and/or follow-up experience, with demonstrated expertise in the full hospital revenue cycle
• 2+ years of supervisory or management experience leading billing and/or account follow-up staff

Preferred:
• Experience/understanding of Medi-Cal and California payor nuances, including Medical Group/Independent Physician Associations (“IPA”)
• Epic certification in Resolute Professional Billing and/or Claims
• Experience leading teams through an Epic implementation, conversion, or major upgrade
• Certified Revenue Cycle Professional (CRCP), Certified Healthcare Financial Professional (CHFP), Certified Revenue Cycle Representative (CRCR), or similar credential
• Experience with payor contract analysis and underpayment recovery
• Experience with process improvement methodologies (e.g., Lean, Six Sigma)
• Experience with Epic reporting tools (Reporting Workbench, SlicerDicer) for operational and trend analysis