Saratoga-Schenectady Gastroenterology Associates is seeking a Medical Billing Manager to support the revenue cycle. We are looking for a highly motivated, friendly, professional and flexible individual who enjoys a challenge and is committed to maximizing the efficiencies of the organization.
This is a full time Monday-Friday 8:00am-5:00pm position.
The Medical Billing Manager directs the complete revenue cycle operations for a 10-room Ambulatory Surgery Center (ASC), a 26-provider multi-specialty medical practice, and a high-volume outpatient infusion center. This role provides strategic leadership over facility and professional billing teams to maximize reimbursement, ensure coding accuracy, minimize denials, and enforce compliance across distinct reimbursement models.
Key Responsibilities
Multi-Facility Revenue Cycle Management
· Dual Billing Streams: Oversees both UB-04 facility billing for the ASC and CMS-1500 professional billing for the 26-provider group.
· Infusion Optimization: Manages complex drug billing, ensuring accurate capture of high-cost J-codes, waste reporting (JW/JZ modifiers), and complex infusion administration codes.
· Prior Authorization & Eligibility: Sets strict workflows for pre-certifications and prior authorizations, particularly for high-cost biologic drugs and elective surgical procedures.
· Denial & Appeals Management: Analyzes complex payer denials, coordinates clinical appeals, and implements strategies to mitigate recurring revenue leakage.
· A/R & Collections Control: Tracks accounts receivable aging metrics across all three entities, maintaining Days Sales Outstanding (DSO) within target thresholds.
Team Leadership & Operations
· Department Supervision: Recruits, trains, and evaluates a team of billers, coders, and payment posters across multiple distinct departments.
· Performance Standardizing: Develops Key Performance Indicators (KPIs) for clean claim rates, data entry speeds, and error reductions.
· Interdepartmental Alignment: Partners with clinical directors, surgery schedulers, and facility administrators to resolve documentation bottlenecks.
Compliance, Auditing & Reporting
· Regulatory Compliance: Enforces strict adherence to HIPAA, OIG guidelines, and evolving Medicare/Medicaid regulations specific to ASC and infusion rules.
· Coding Quality Audits: Coordinates regular internal audits of ICD-10-CM, CPT, and HCPCS coding to identify and rectify discrepancies.
· Financial Reporting: Generates and presents comprehensive monthly revenue cycle reports, trend analyses to leadership.
Required Qualifications
· Experience: Minimum of 5–7 years in healthcare revenue cycle management, with at least 3 years directly overseeing ASC facility billing or specialty infusion billing.
· Credentials: Certified Professional Biller (CPB) or Certified Professional Coder (CPC) highly required.
· Technical Mastery: Deep knowledge of UB-04 and CMS-1500 claims architectures, electronic health records (EHR), practice management systems, and clearinghouses.
· Experience with eClnicalworks is a plus.
· Experience with Contract Management preferred but not required.
Pay: $85,000.00 - $115,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Health savings account
- Paid time off
- Vision insurance
Work Location: In person
