At AccessPoint RI, we believe strong financial operations are essential to delivering high-quality services and support to the individuals and communities we serve. We are seeking a detail-oriented, analytical, and solutions-focused Billing Manager to lead and oversee the organization's billing and reimbursement processes.
In this role, you will serve as a key member of the Finance team, ensuring the accurate and timely processing of claims, payments, and reimbursements. You will manage the full billing cycle, including payment posting, claim resolution, Electronic Data Interchange (EDI) transmissions, and reconciliation activities. Your expertise will help maximize revenue integrity, maintain compliance, and support the financial sustainability of our programs.
The ideal candidate thrives in a fast-paced environment, enjoys problem-solving, and has a strong understanding of Developmental Disability Organization (DDO) billing practices. You will collaborate closely with program leadership, finance staff, and external payers to identify and resolve billing discrepancies, improve processes, and ensure efficient revenue cycle management.
This position reports directly to the Chief Financial and Administrative Officer and offers the opportunity to make a meaningful impact behind the scenes by supporting the systems that allow our organization to fulfill its mission.
If you are a proactive professional who values accuracy, accountability, and continuous improvement, we invite you to join a team where your expertise helps drive organizational success every day.
Duties and Responsibilities:
- This position is responsible for billing Medicaid and other insurers including United Health Care, Optum, BCBS, and NHPRI.
- Billing is time-sensitive and must be submitted on time in accordance with Medicaid and other insurer requirements.
- Manage Purchase Orders (PO) with Medicaid ensuring all client contracts in Sandata match the current PO.
- Maintaining client contracts in Sandata when changes occur for clients.
- Work with the CFAO and the CEO to ensure that no gaps in client services occur.
- Post client payments, adjustments, and denials from remittance advice accurately and in timely manner.
- Research and resolve claim rejections, denials, and underpayments by communicating regularly with payers and internal departments.
- Monitor and manage EDI transactions, including claims submissions, remittance advice and eligibility verifications.
- Manage and maintain all billing documentation on APRI servers.
- Maintain accurate documentation of billing activities, including each of APRI’s Program’s billing process, payment posting, claim follow-up, and EDI troubleshooting.
- Identify and resolve EDI rejections and errors to ensure successful electronic transmission and payment.
- Respond to all reasonable expectations of the agency and/or supervisor.
- High School diploma or equivalent.
- Minimum of 5 years’ experience with Gainwell, United Health Care, Neighborhood Health Plan Rhode Island billing portals and clearing houses.
- Experience working in Developmental Disability Organizations.
- Experience with 835 and 837 file management.
- Hands on experience with Sandata Accounting Software.
- Familiarity with Gainwell Technologies and BHDDH authorizations.
- Familiarity with denial management and appeal processes.
- Solid understanding of timeliness of filing rules for payers.
- Ability to interpret remittance advice and act on denied or suspended claims immediately.
