Postgraduate Center for Mental Health
Insurance and Billing Operations Manager
Postgraduate Center for Mental Health, New York, New York, us, 10261
Insurance and Billing Operations Manager
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Insurance and Billing Operations Manager
role at
Postgraduate Center for Mental Health
1 day ago Be among the first 25 applicants
This role ensures that clients receive timely access to services, billing is accurate and compliant, and insurance inquiries and disputes are resolved efficiently. The Manager serves as the primary liaison between clinical teams, billing departments, insurance carriers, and administrative leadership, ensuring a seamless revenue cycle from intake through reimbursement.
Base pay range $79,824.00/yr - $90,000.00/yr
Key Responsibilities Insurance Eligibility & Verification
Oversee the daily verification of insurance eligibility for new and returning clients
Ensure authorizations, referrals, and required documentation are obtained prior to service
Monitor ongoing eligibility changes and communicate updates to clinical and administrative teams
Resolve complex eligibility issues, including lapses, denials, and changes in coverage
Manage the billing workflow for two mental health clinics, ensuring accurate and timely claim submission
Monitor claim status, address rejections, and work closely with billing partners to resolve denials
Conduct routine audits of billing accuracy, CPT coding alignment, and documentation compliance
Track and report on revenue cycle KPIs (e.g., days in A/R, denial rate, clean claim rate)
Dispute Resolution & Insurance Communication
Serve as point person for escalated billing and insurance disputes from clients, staff, and insurance carriers
Collaborate with insurance representatives to resolve reimbursement discrepancies or claim issue
Maintain clear documentation of communications, appeals, and dispute resolutions
Clinic Support & Collaboration
Partner with clinic leadership to ensure staff are following required insurance and billing procedures
Train front-desk, intake, and clinical staff on eligibility workflows, documentation standards, and billing expectations
Provide recommendations for process improvements to increase efficiency and reduce revenue loss
Compliance & Quality Assurance
Ensure compliance with federal, state, and payer regulations, including HIPAA, OMH/DOHMH requirements, and insurer guidelines
Keep leadership informed of insurance policy updates impacting billing or eligibility
Develop and maintain SOPs for eligibility checks, billing escalations, and dispute resolution
Insurance Contracting, Networking & Payer Relations
Build and maintain strong working relationships with insurance carriers and provider networks
Serve as the primary contact for payer representatives regarding clinic billing, claims, credentialing, and operational needs
Support negotiation, renewal, and implementation of insurance contracts, fee schedules, and authorization requirements
Monitor contract performance and identify opportunities to expand payer participation and improve reimbursement rates
Attend payer meetings, webinars, policy updates, and networking sessions to stay informed of changes impacting behavioral health services
Collaborate with leadership to ensure compliance with payer standards, credentialing requirements, and regulatory updates
Qualifications
Bachelor’s degree in Business, Healthcare Administration, Finance, or related field (Master’s preferred)
Minimum 3–5 years of experience in healthcare billing, insurance eligibility, or revenue cycle management (behavioral health preferred)
Strong knowledge of commercial plans, Medicaid, Medicare, and managed care
Experience working with EHR and billing platforms
Excellent communication, analytical, and problem‑solving skills
Ability to work independently, manage competing priorities, and support multiple clinic sites
Seniority level
Director
Employment type
Full‑time
Job function
Finance, Administrative, and General Business
Mental Health Care and Insurance
#J-18808-Ljbffr
Insurance and Billing Operations Manager
role at
Postgraduate Center for Mental Health
1 day ago Be among the first 25 applicants
This role ensures that clients receive timely access to services, billing is accurate and compliant, and insurance inquiries and disputes are resolved efficiently. The Manager serves as the primary liaison between clinical teams, billing departments, insurance carriers, and administrative leadership, ensuring a seamless revenue cycle from intake through reimbursement.
Base pay range $79,824.00/yr - $90,000.00/yr
Key Responsibilities Insurance Eligibility & Verification
Oversee the daily verification of insurance eligibility for new and returning clients
Ensure authorizations, referrals, and required documentation are obtained prior to service
Monitor ongoing eligibility changes and communicate updates to clinical and administrative teams
Resolve complex eligibility issues, including lapses, denials, and changes in coverage
Manage the billing workflow for two mental health clinics, ensuring accurate and timely claim submission
Monitor claim status, address rejections, and work closely with billing partners to resolve denials
Conduct routine audits of billing accuracy, CPT coding alignment, and documentation compliance
Track and report on revenue cycle KPIs (e.g., days in A/R, denial rate, clean claim rate)
Dispute Resolution & Insurance Communication
Serve as point person for escalated billing and insurance disputes from clients, staff, and insurance carriers
Collaborate with insurance representatives to resolve reimbursement discrepancies or claim issue
Maintain clear documentation of communications, appeals, and dispute resolutions
Clinic Support & Collaboration
Partner with clinic leadership to ensure staff are following required insurance and billing procedures
Train front-desk, intake, and clinical staff on eligibility workflows, documentation standards, and billing expectations
Provide recommendations for process improvements to increase efficiency and reduce revenue loss
Compliance & Quality Assurance
Ensure compliance with federal, state, and payer regulations, including HIPAA, OMH/DOHMH requirements, and insurer guidelines
Keep leadership informed of insurance policy updates impacting billing or eligibility
Develop and maintain SOPs for eligibility checks, billing escalations, and dispute resolution
Insurance Contracting, Networking & Payer Relations
Build and maintain strong working relationships with insurance carriers and provider networks
Serve as the primary contact for payer representatives regarding clinic billing, claims, credentialing, and operational needs
Support negotiation, renewal, and implementation of insurance contracts, fee schedules, and authorization requirements
Monitor contract performance and identify opportunities to expand payer participation and improve reimbursement rates
Attend payer meetings, webinars, policy updates, and networking sessions to stay informed of changes impacting behavioral health services
Collaborate with leadership to ensure compliance with payer standards, credentialing requirements, and regulatory updates
Qualifications
Bachelor’s degree in Business, Healthcare Administration, Finance, or related field (Master’s preferred)
Minimum 3–5 years of experience in healthcare billing, insurance eligibility, or revenue cycle management (behavioral health preferred)
Strong knowledge of commercial plans, Medicaid, Medicare, and managed care
Experience working with EHR and billing platforms
Excellent communication, analytical, and problem‑solving skills
Ability to work independently, manage competing priorities, and support multiple clinic sites
Seniority level
Director
Employment type
Full‑time
Job function
Finance, Administrative, and General Business
Mental Health Care and Insurance
#J-18808-Ljbffr