Overview
Job Description - Manager Hospital Billing & Collections SH)
Description: Manages all aspects of hospital billing and DNFB. Responsible for ensuring compliance to all regulatory bodies as well as payer specific requirements. Understands hospital reimbursement methodologies and evaluates any billing changes against expected reimbursement. Ensures goals are achieved by maintaining fluent processing for timely claim submission. Identifies, monitors and reports issues as they arise and appropriate resolutions. Identifies and coordinates performance improvement initiatives both internal and external. Works with all levels of staff, management and payers to reduce denials and underpayments. Well versed in all aspects of the revenue cycle and the impact to billing. Works closely with the professional billing manager to understand the impact of updates, system changes and processes on their team.
Responsibilities
- Lead and manage all aspects of hospital billing and DNFB to ensure timely and accurate claim submission.
- Ensure compliance with regulatory bodies and payer requirements; evaluate reimbursement methodology changes and impact.
- Identify, monitor, and report issues; coordinate timely resolutions and performance improvement initiatives with internal and external stakeholders.
- Collaborate with staff at all levels and with payers to reduce denials and underpayments.
- Maintain fluency across the revenue cycle and work with the Professional Billing Manager on impacts of updates and system changes.
Qualifications
- Minimum Education : Bachelor’s Degree (Required)
- Minimum Work Experience : 3 years related and progressive experience (Required) and 2 years management experience in a healthcare or related field (Required)
- Required Skills/Knowledge :
- Excellent oral and written communication
- Excellent computer skills, preferably with Access and Excel
- Strong analytical skills
- Well versed in all aspects of the revenue cycle
- Analytical problem solver
- Focused on compliance, key performance indicators and efficiency
- Ability to quickly assess procedures and implement resolutions
- Demonstrates collaboration, team spirit and a positive motivating environment
Functional Accountabilities
Staff Supervision
- Manage human resource activities of assigned team members, including selection, termination, training and development, evaluation and scheduling.
- Develop staff qualifications and performance criteria; update Director on staff performance; participate in staff development and selection.
- Update staff with relevant information from Hospital and CNMA via written communication or staff meetings.
- Represent staff interests in committees.
- Coordinate workflow of staff, considering workload, priorities and resources; promote an environment to support and recognize contributions.
- Document policies and procedures; communicate development and change to staff; contribute to ongoing review.
Operations Management
- Lead or co-lead denial work groups; manage reports, data, and root cause analysis; ensure progressive action to reduce denials and underpayments.
- Coordinate projects related to payer performance; work with Managed Care and others to address issues.
- Identify potential billing compliance issues, assess risk, research resolutions; collaborate with Compliance Department and report decisions affecting accounts receivable.
- Work with Federal, State, and local authorities on regulatory issues affecting submission and adjudication of bills.
- Support decision making with operational data and information.
- Implement strategic plans through day-to-day management; troubleshoot operational barriers and collaborate with Director on significant issues.
Accounts Receivable Management
- Review Accounts Receivable to identify problems and work toward resolution; monitor data entry quality; follow up on performance issues with management and staff.
- Monitor accounts daily to maximize reimbursement opportunities; support staff in account development; develop tools to improve efficiency.
- Audit managed care contract compliance and payer performance; report findings and implement corrective actions; resolve discrepancies in PCON & Trendstar.
- Manage recoveries of underpayments/appeals using internal and external resources; provide documentation and reports.
- Review denial trends and coordinate process improvements; manage bad debt processes and vendor relationships as appropriate.
- Develop and maintain communication with third-party payers; stay informed of contractual and policy requirements related to denials and reimbursement.
Billing and Prebilling Management
- Manage facility billing team to ensure timely, accurate, and compliant billing of accounts receivable; oversee prebilling, including DNFB for IP & OP; ensure reconciliation of authorization processes.
- Oversee daily import/export processes with STAR and TSH acknowledgement reports; monitor biller/payer report assignments and rebilling of denied claims; communicate changes to staff and affected departments.
- Monitor changes in daily failed volume and payer mix and align with staff assignments.
- Research Federal, CPT, ICD9, HIPAA and local billing transmission standards for 837 and UB92 filing; communicate requirements to applicable departments.
- Collaborate with Managed Care Department to resolve payer-related billing issues.
Organizational Accountabilities
Organizational Accountabilities (Staff); Organizational Commitment/Identification; Teamwork/Communication; Performance Improvement/Problem-solving; Cost Management/Financial Responsibility; Safety
Location and Job Details
Primary Location: Maryland-Silver Spring
Work Locations: Tech Hill 12211 Plum Orchard Drive Silver Spring 20904
Job: Management
Organization: Finance
Position Status: R (Regular) - FT - Full-Time
Shift: Day
Work Schedule: 8-5pm
Job Posting
Sep 4, 2025, 4:26:09 PM
Salary Range
Full-Time Salary Range: 77646.4 - .8
The Children’s National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “Know Your Rights” poster is available here and the pay transparency poster is available here: Know Your Rights and Pay Transparency/Nondiscrimination Poster.
Please note that it is the policy of Children’s National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children’s National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.
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