Out of Network Billing Manager

We are seeking a dynamic and detail-oriented Out of Network Billing Manager to lead our billing operations for multiple specialties, including but not limited to, neurospine, orthopaedic spine, general surgery, vascular and pain management. In this pivotal role, you will oversee the entire billing lifecycle, ensuring accurate claim submission, timely follow-up, and resolution of complex out-of-network claims. Your expertise will drive efficiency, maximize reimbursements, and enhance our relationships with payers and patients alike. Join us to champion transparent, compliant, and proactive billing practices that support our mission to deliver exceptional healthcare experiences. In order to be considered for this position you must have experience with out of network surgical claims., * Manage the end-to-end process of out-of-network billing, including claim preparation, submission, and follow-up to ensure prompt reimbursement.

• Review and analyze complex insurance claims to identify discrepancies, denials, or underpayments, then develop strategies for resolution.
• Collaborate with clinical teams and insurance payers to resolve billing issues swiftly and accurately.
• Maintain detailed records of all billing activities, correspondence, and adjustments for audit readiness and reporting purposes.
• Develop and implement policies and procedures to optimize out-of-network billing workflows while ensuring compliance with industry regulations.
• Train and mentor billing staff on best practices for handling out-of-network claims, appeals, and payer negotiations.
• Monitor key performance indicators related to claim turnaround times, denial rates, and reimbursement levels to continuously improve processes.

• Proven experience managing out-of-network medical billing operations in a fast-paced healthcare environment.
• Strong understanding of insurance policies, coding standards (such as CPT/HCPCS), and payer-specific requirements.
• Exceptional analytical skills with the ability to interpret complex claims data and identify root causes of issues.
• Excellent communication skills for effective collaboration with internal teams, insurance representatives, and patients.
• Proficiency with billing software systems and electronic health record platforms; familiarity with clearinghouses is a plus.
• Detail-oriented mindset with strong organizational skills to handle multiple priorities simultaneously.
• Knowledge of compliance standards such as HIPAA regulations related to patient privacy and billing practices. Join us as an Out of Network Billing Manager to lead a vital component of our healthcare revenue cycle! Your expertise will ensure smooth operations, maximize revenue recovery, and uphold the highest standards of accuracy and transparency in out-of-network billing processes. We’re committed to supporting your professional growth as you help shape a seamless billing experience for our patients and partners alike!

2.82.8 out of 5 stars Remote $42,000 - $55,000 a year - Full-time, Pulled from the full job description

• Paid time off, Pay: $42,000.00 - $55,000.00 per year

Benefits:

• Paid time off