CAH-Billing Manager in Carthage, New York at Claxton-Hepburn Medical Center

The Billing Manager provides leadership and oversight of the hospital's insurance accounts
receivable operations, with a primary focus on timely reimbursement, denial prevention and
resolution, payer follow-up, and accounts receivable performance. This position is responsible
for managing complex insurance claims, coordinating with commercial, Medicare, Medicaid, and
managed care payers, and ensuring accurate reimbursement through proactive follow-up and
escalation.
The position monitors payer trends, denial patterns, regulatory changes, and reimbursement
policies to ensure compliance while implementing process improvements that reduce denials,
improve collections, and decrease accounts receivable days outstanding. Through effective use
of the Revenue Cycle System, the Billing Manager evaluates workflow efficiencies, develops
staff, and ensures operational excellence while achieving industry benchmark performance
metrics.
Essential Responsibilities
Provide leadership and oversight of insurance accounts receivable operations.
Manage and monitor insurance A/R work queues to ensure timely claim resolution and
reimbursement.
Lead denial management efforts, including identifying trends, root cause analysis,
appeals, and corrective action planning.
Work directly with commercial, Medicare, Medicaid, and managed care payer
representatives to resolve complex claim and payment issues.
Escalate unresolved payer issues through provider representatives and payer liaison
channels when necessary.
Monitor payer reimbursement accuracy and identify underpayments or contract
compliance concerns.
Ensure timely billing, follow-up, and payment of hospital claims while maintaining
compliance with federal, state, and payer regulations.
Monitor key revenue cycle performance indicators including A/R Days, Aging, Denial
Rate, Clean Claim Rate, First Pass Resolution, and Cash Collections.
Analyze payer trends and develop strategies to reduce denials and improve
reimbursement performance.
Identify workflow improvements and automation opportunities within the Revenue Cycle
System to increase operational efficiency.
Develop departmental policies and procedures that support best practices in insurance
billing and collections.
Supervise, mentor, and develop billing staff while establishing productivity and quality
expectations.
Prepare and present revenue cycle performance reports to executive leadership.
Maintain knowledge of payer policies, reimbursement methodologies, regulatory
requirements, and industry best practices.
Reports To
Director of Revenue Cycle
Education
Required
High School Diploma or equivalent
Preferred
Bachelor's degree in Business, Healthcare Administration, Finance, or related field.
Training & Experience
Required
Minimum of five (5) years of progressive hospital insurance billing, accounts receivable,
or revenue cycle experience.
Demonstrated experience in insurance follow-up, denial management, and payer
reimbursement.
Working knowledge of Medicare, Medicaid, commercial insurance, and managed care
billing requirements.
Preferred
Three (3) years of supervisory or management experience in a healthcare revenue cycle
environment.
Experience with hospital billing systems, EDI processes, and revenue cycle analytics.
Knowledge of revenue cycle KPIs, payer contract reimbursement methodologies, and
regulatory compliance.