Billing Operations Manager - Personal Injury & Workers'...

OverviewThe PI/WC Billing Manager is responsible for leading and overseeing the operations of the Personal Injury and Workers’ Compensation function. This role focuses on managing a team of coordinators, optimizing workflows, ensuring compliance with legal and ethical standards, driving performance outcomes, ensuring that departmental goals align with organizational objectives and that all PI/WC cases are handled efficiently and professionally.Key ResponsibilitiesTeam Leadership & OversightSupervise and support a team of PI/WC coordinators, ensuring clarity of roles, accountability, and high performance.Provide coaching, training, and development opportunities to team members to enhance skills and knowledge.Monitor team productivity and quality metrics and implement performance improvement plans as needed.Foster a collaborative, professional, and positive team culture.Workflow & Process ManagementDesign, implement, and continuously improve workflows for PI/WC case management, billing, and documentation.Ensure timely verification, submission, and follow-up of claims through effective delegation and oversight.Establish and maintain standardized procedures to ensure consistency, accuracy, and compliance across all cases.Coordinate cross-functional collaboration with billing, clinical, and legal teams to streamline pliance & Quality AssuranceEnsure all PI/WC processes comply with HIPAA, state lien laws, and personal injury statutes.Conduct regular audits of open and closed cases to ensure documentation accuracy and ethical billing practices.Stay current on regulatory changes and industry best practices and update departmental protocols accordingly.Stakeholder CommunicationServe as the primary escalation point for complex or high-risk cases involving insurance companies, attorneys, or providers.Maintain strong relationships with internal and external stakeholders to facilitate case resolution and settlement negotiations.Provide regular updates to leadership on departmental performance, challenges, and opportunities for improvement.Technology & ReportingOversee the effective use of EHR systems and departmental software to track case progress and performance metrics.Ensure accurate and timely reporting of departmental KPIs, including case turnaround times, settlement rates, and outstanding balances.Leverage data to identify trends, forecast needs, and support strategic decision-making.QualificationsMinimum Qualifications5+ years of experience in healthcare billing, with a focus on personal injury and workers’ compensation.Strong understanding of insurance guidelines, lien laws, and HIPAA compliance.Proven experience managing or leading a team in a healthcare or revenue cycle environmentQualifications2+ years of supervisory experience in a healthcare or legal billing setting.Familiarity with EHR systems and case management software.Job CompetenciesStrategic thinking and process optimizationTeam leadership and staff developmentStrong communication and interpersonal skillsAnalytical mindset with attention to detailAbility to manage competing priorities in a fast-paced environmentProfessionalism and composure in high-stakes situationsAdditional Information#ZRDisclaimerAll team members agree to consistently support compliance and TVG-Medulla, LLC policies and Standards of Excellence with regard to maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, adhering to applicable federal, state, and local laws and regulations, accreditation, and licenser requirements (if applicable), and Medulla procedures and protocols. Must perform other related duties and assist with project completion as needed. Team member may be required to provide necessary information to complete a DMV (or equivalent agency) background check. #J-18808-Ljbffr

Created: 2025-09-23