Medical Billing Manager

Required Skills & Experience

• 5+ years of medical billing/revenue cycle experience within an ambulatory or outpatient healthcare environment
• 2+ years of infusion billing experience, including J-codes and pharmacy benefits
• 2+ years of direct leadership or supervisory experience -2+ years of hands-on Epic experience within billing/revenue cycle workflows
• Strong experience working with a combination of commercial, Medicare, Medicaid/Medi-Cal, and government payers
• Advanced understanding of CPT, ICD-10, HCPCS codes, modifiers, denials, and appeals
• Knowledge of claim reimbursement, coding accuracy, and procedure/diagnosis compatibility
• Bachelor's degree in Healthcare Administration, Finance, or related field, or equivalent professional experience
• Medical billing education or training
• CPB, CMBS, billing/coding certification, or similar credential
• BLS and HIPAA training, or ability to obtain after hire

Nice to Have Skills & Experience

• Experience with CCS and/or GHPP
• Prior billing experience supporting hematology, infusion, specialty pharmacy, or complex specialty care

Job Description

An employer is seeking an experienced Medical Billing Manager to join a mission-driven healthcare organization in Orange County. This individual will oversee day-to-day billing and reimbursement operations for both clinical and infusion services while leading a team of 3 billing and collections professionals.

The ideal candidate will bring strong hands-on knowledge of outpatient medical billing, infusion reimbursement, payer requirements, and Epic workflows. This person will also be responsible for improving revenue cycle performance, reducing denials and aging A/R, and ensuring billing practices remain compliant with government and commercial payer guidelines.

Key Responsibilities

• Lead daily revenue cycle operations, including charge entry, claim review/submission, payment posting, collections, and account follow-up
• Manage, train, and support a team of onsite and remote billing professionals
• Oversee infusion billing, including J-codes, pharmacy benefits, and reimbursement workflows
• Monitor and resolve Epic billing, claim, account, and charge-related workqueues
• Review denied and rejected claims, identify trends, and develop appropriate appeal or resolution strategies
• Monitor A/R aging, DSO, reimbursement trends, and monthly revenue cycle KPIs
• Maintain compliance with CMS, Medicare, Medi-Cal/Medicaid, commercial payers, and managed care requirements
• Ensure accurate application of CPT, ICD-10, HCPCS, E&M codes, and modifiers
• Maintain payer information and address escalated billing or reimbursement concerns
• Support billing processes involving CCS, GHPP, Medi-Cal, and other government-sponsored programs

Schedule: Monday-Friday, 8:30 AM-5:00 PM Work Model: Hybrid, 3 days onsite / 2 days remote PTO: 4+ weeks per year 10 paid holidays Medical and vision coverage with 100% employee premium coverage and 50% dependent coverage Dental coverage with 99% of employee premium covered Employer-provided life insurance 403(b) retirement plan with 4% employer match