Manager, Claims Billing (VBC)

Manager, Claims Billing (VBC)

Houston, United States of America | Hybrid

As the Billing Manager, Value-Based Care (VBC) Operations, you will lead the billing function for a portfolio of specialty care provider clients, ensuring strong financial performance, operational excellence, and exceptional client satisfaction. You will oversee a team of Billing Coordinators, drive revenue cycle performance, and play a critical role in optimizing billing and collections processes within a growing value-based care environment.

Reporting to the Director of VBC Operations, this individual plays a critical role in supporting value-based care initiatives, including bundled payment solutions. The Billing Manager will help ensure billing operations effectively support evolving reimbursement models by monitoring financial performance, identifying reimbursement opportunities, managing denials and appeals, and improving operational workflows that drive quality outcomes and financial results.

Through data-driven decision making and collaboration with operational, clinical, coding, credentialing, and financial teams, the Billing Manager will help optimize reimbursement, reduce accounts receivable aging, improve operational efficiency, and support the successful delivery of value-based care and bundled payment programs.

Roles & Responsibilities

• Lead and oversee professional billing operations, including claim submission, payment posting, denial management, appeals, and accounts receivable follow-up.
• Manage, coach, and develop billing staff through hiring, onboarding, training, performance management, and ongoing professional development.
• Partner closely with the Collections Manager and collections team to optimize revenue cycle performance, reduce aging accounts receivable, and improve collection outcomes.
• Monitor key revenue cycle metrics and identify opportunities to improve billing accuracy, reimbursement performance, and operational efficiency.
• Analyze reimbursement trends, payer performance, denials, and accounts receivable data to drive informed business decisions.
• Partner with coding, credentialing, operations, finance, and client service teams to improve charge capture, reduce claim rejections, and optimize reimbursement.
• Ensure compliance with payer requirements, CMS regulations, contractual obligations, and company policies.
• Oversee denial management activities, including root cause analysis, appeals, and corrective action plans.
• Support payer contract reimbursement reviews, underpayment identification, and payment variance analysis.
• Develop and maintain billing policies, procedures, workflows, controls, and departmental performance standards.
• Lead process improvement initiatives that enhance scalability, productivity, and revenue cycle outcomes.
• Prepare and present reporting and recommendations to leadership regarding operational performance and financial results.
• Participate in client-facing discussions related to billing performance, reimbursement trends, and revenue cycle outcomes.
• Support value-based care and bundled payment initiatives by monitoring billing performance, identifying reimbursement opportunities, and ensuring alignment with program and client objectives.

Experience / Qualifications

• 5+ years of experience in professional medical billing, revenue cycle management, or healthcare reimbursement, including at least 2 years of experience leading billing, collections, accounts receivable, or revenue cycle teams.
• Demonstrated expertise managing the full professional billing lifecycle, including claim submission, payment posting, denial management, appeals, accounts receivable follow-up, and reimbursement optimization.
• Strong understanding of Medicare, Medicaid, commercial, and managed care reimbursement methodologies, payer requirements, and revenue cycle best practices.
• Experience analyzing billing data, reimbursement trends, KPIs, payer performance, and accounts receivable metrics to drive operational improvements and financial results.
• Proficiency with practice management systems, revenue cycle platforms, electronic health records (EHRs), Microsoft Excel, and reporting tools.
• Proven leadership, coaching, problem-solving, and organizational skills, with the ability to manage multiple priorities in a fast-paced healthcare environment.
• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field preferred; equivalent combination of education and experience will be considered.
• Cardiovascular billing experience strongly preferred. Experience in a physician practice, MSO, specialty medical group, ambulatory care setting, value-based care environment, or population health program is preferred.
• Preference for those with professional certification such as CPC, CPB, CRCP, or equivalent.
• Knowledge of CPT, ICD-10, and HCPCS coding concepts, payer contract reimbursement analysis, and underpayment identification is preferred.
• To be eligible for this position, you must reside in the same country where the job is located.