Senior Billing Manager at Venture Medical, LLC Senior Billing Manager at Venture Medical, LLC in Missoula, Montana Posted in 4 days ago.

Type:

full-time

POSITION TITLE

Senior Billing Manager

LOCATION

Remote.

FLSA STATUS

Exempt (administrative), determined under the FLSA and applicable state law. If the state salary threshold or duties test is not met, the position is non-exempt in that state.

REPORTS TO

Director of Digital Solutions and Services

DOTTED LINE

Controller (accounting for billed items)

SUPERVISORY RESPONSIBILITY

None at hire; supervises billing staff as headcount grows.

DEPARTMENT

Digital Solutions and Services

COMPENSATION

$95,000-$110,000 annually, plus optional medical/dental/vision insurance (partially employer-paid), 401(k), and incentive compensation opportunity.

CHARACTERISTICS OF THE POSITION

The Senior Billing Manager owns billing design, standards, and performance across Venture Medical, LLC and its affiliates SOPs, edit rules, payer playbooks, coverage/coding policy interpretation, escalation criteria, and performance metrics exercising discretion and independent judgment on matters of significance, including payer strategy, appeal posture, root-cause remediation, and system design. The role also performs hands-on claim work as needed, builds and leads a billing team as volume supports it, and partners closely with Reimbursement, Systems Development, Compliance, and Finance as the Companys billing

SME. ESSENTIAL DUTIES

The duties below under Standards, Oversight, and Independent Judgment and Claim Execution and Follow-Up are essential functions under the ADA and applicable state law. This list is not exhaustive. Standards, Oversight, and Independent Judgment Develop, maintain, and enforce SOPs, work instructions, payer playbooks, and billing edit rules; standardize workflows across all lines of business. Interpret LCDs, NCDs, coverage articles, payer policy, and fee schedule changes and how they apply to Company billing; set escalation, adjustment, and write-off criteria within delegated authority. Partner with Systems Development to define requirements, test releases, and refine billing, edit, and reporting logic in Ventures digital tools. Track and report billing metrics clean claim rate, first-pass yield, DSO, denial rate, appeal overturn rate, AR >90 days by payer/line; set corrective action and remediation priorities.

Build the billing function:

define staffing plan, participate in hiring, develop training materials, and supervise billing staff as volume warrants. Serve as SME on billing across surgical dressings, institutional, and mobile wound care; provide direction, troubleshooting, and quality oversight to internal teams and partner providers. Comply with the Companys Code of Conduct and compliance programs, complete assigned compliance/HIPAA training, and report suspected billing errors or compliance concerns through Company channels. The Company does not retaliate against good-faith reporting. Claim Execution and Follow-Up Oversee, and as needed personally perform, preparation, scrubbing, and submission of clean claims across all lines through clearinghouse and payer portals.

Work claims through adjudication:

resolve front-end/clearinghouse rejections, correct and resubmit within SLA standards, and monitor status via CMS systems and payer portals. Own denial management end to end identify root cause by payer, code, product, and provider; prepare corrected claims, reconsiderations, redeterminations, and higher-level appeals with supporting clinical documentation. Apply accurate

HCPCS/CPT

coding, modifiers, revenue codes, units, and place of service; validate code-to-coverage alignment against LCDs/NCDs and payer policy before submission. Reconcile remittance advice, post payments/adjustments, and resolve underpayments, overpayments, credit balances, and refunds; promptly escalate suspected overpayments to Compliance and Finance to satisfy any report-and-return obligation. Manage AR and aging follow-up; prioritize high-dollar and at-risk balances and escalate systemic payer issues to Finance and management. Coordinate with Reimbursement on IVR outcomes, prior authorization status, and documentation sufficiency; run insurance verification and submit authorizations as needed. Support responses to payer and government audits by assembling records packages and tracking outcomes. Maintain accurate, complete, compliant documentation in billing systems and CRM per HIPAA and company policy. Access PHI only as necessary (minimum necessary), and maintain a secure, private remote environment per Company remote-work/workstation security policies. Plan and organize workload to meet billing calendars and filing deadlines.

RELATED DUTIES

Provide billing input to provider/supplier enrollment, revalidation, and credentialing (PECOS, DMEPOS standards, facility/group enrollment); maintain NPI/taxonomy/roster accuracy. Assist Finance with month-end close, revenue/cash reconciliation, and data supporting reserve estimates and write-off review. Participate in cross-functional projects on annual HCPCS/CPT and fee schedule changes, new product launches, and payer contracting analysis/onboarding (DME, Medicare Advantage/commercial).

MINIMUM QUALIFICATIONS

Minimum Training and Experience 8+ years of medical billing experience with progressive responsibility, incl. 3+ years senior/lead/supervisory, and experience building or rebuilding a billing/revenue cycle function. Working knowledge of Medicare Part

A/B, DME MAC

rules, Medicare Advantage, Medicaid, and commercial payer billing, incl. institutional, professional (CMS-1500), and DMEPOS surgical dressing billing. Experience with clearinghouse platforms, payer portals, EDI transaction sets, billing systems, and CRM platforms; HIPAA compliance knowledge required. High school diploma or equivalent required. Employment is, and remains, contingent on clearing screening against the HHS-OIG List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM) exclusion list, and applicable state Medicaid exclusion lists; screening repeats monthly. Preferred CPC, CPB, CRCR, or equivalent certification. Billing experience in more than one setting surgical dressing DMEPOS, institutional, and/or advanced wound care. Postsecondary coursework or a degree in health administration, business, or a related field. Minimum Knowledge, Abilities and Skills Deep knowledge of

HCPCS/CPT

coding, modifier logic, NCCI edits, medical necessity documentation, and LCD/NCD coverage criteria. Able to read and interpret remittance advice, payer policy, fee schedules, and coverage articles, and apply them to billing practice. Strong analytical skills trend denials, quantify revenue impact, propose corrective action; Excel proficiency required. Able to communicate professionally and persuasively with payers, providers, and internal stakeholders on escalated and appeal-level matters. High comfort with technology and strong organizational skills quick to learn new platforms, give structured feedback to development teams, and manage competing priorities against filing/month-end deadlines. Able to work independently in a lean environment while building process and structure for a growing team, with sound judgment, integrity, and a compliance-first orientation.

PHYSICAL REQUIREMENTS

Able to operate a computer, telephone, and standard office equipment, and communicate by phone and video conference. Ability to work at a computer for extended periods. Reasonable accommodations will be made to enable individuals with disabilities to perform essential functions of this position. To request an accommodation, contact [HR contact].

WORKING CONDITIONS

Remote work environment. This position is not office-based. Remote work is available only from states where the Company is registered and runs payroll; the Company may decline candidates residing outside those states. Occasional travel may be required for training, audits, or team meetings. This job description describes the general nature and level of assigned work. It is not exhaustive; the incumbent may be assigned other duties, and the Company may modify this description at any time. It is not a contract of employment, does not guarantee employment for any period, and does not alter the employment relationship, which is governed by the applicable offer letter, Company policy, and state law. Venture Medical, LLC is an equal opportunity employer committed to diversity and inclusion. Applicants and employees are considered without regard to race, color, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity, national origin, ancestry, citizenship or immigration status, age, marital status, disability, genetic information, military or veteran status, or any other characteristic protected by applicable federal, state, or local law. The Company provides reasonable accommodations for disabilities and sincerely held religious beliefs. recblid ss3u0de4v9quhhcrfpvsgtd0ghp2i2