GENERAL PURPOSE / SUMMARY OF JOB

The Network Operations Manager serves as a key operational resource supporting Access Advantage and its skilled nursing facility network. This role combines hands-on SNF business office experience, managed care authorization knowledge, payer operations, and revenue-cycle expertise to support member facilities throughout the managed care process - from admission and authorization through billing, claims resolution, and reimbursement. The position works across Operations, Revenue Cycle, Contracting, member facilities, therapy providers, clinical teams, and health plans to resolve issues, improve follow-through, and reduce preventable denials.

ESSENTIAL FUNCTIONS

Managed Care & Network Operations Serve as a liaison among Access Advantage, member facilities, health plans, therapy providers, and other vendors. Support payer contracting implementation, network participation, and operational follow-through. Assist with new facility onboarding and implementation of managed care programs. Maintain payer information, operational requirements, fee schedules, and related network documentation. Troubleshoot payer enrollment, credentialing, or configuration issues that affect authorization or reimbursement. Monitor payer communications and identify changes requiring facility or internal action. Identify systemic payer issues affecting multiple network members and escalate them to Operations leadership. Participate in member calls and translate payer requirements into clear action steps. SNF Business Office & Revenue Cycle Serve as an operational resource to member Business Office Managers and facility leadership. Understand the complete SNF revenue cycle from admission through authorization, billing, payment, denial, appeal, and account resolution. Review and troubleshoot managed care claims, denials, underpayments, remittances, and reimbursement issues. Apply working knowledge of UB-04 billing, bill types, revenue codes, diagnosis codes, modifiers, condition/value/occurrence codes, and payer-specific requirements. Maintain working knowledge of Medicare Part A and Part B billing; Medicare and Medicaid billing experience is a plus and may be used to support operational needs. Assist facilities and internal Revenue Cycle staff with complex billing or payer issues as needed. Coordinate with third-party billing and therapy vendors to resolve outstanding issues. Authorization & Case Management Support Manage and support Part A skilled nursing authorization and recertification processes for Medicare Advantage and other managed care plans. Provide Part B therapy authorization support, including initial requests, extensions, and authorization-related denials. Verify payer requirements and submit required clinical documentation through payer portals and other payer channels. Monitor authorization status and follow up with health plans to support timely approvals. Communicate documentation needs, approvals, denials, and next steps to facility, therapy, and clinical teams. Identify missing, delayed, or incomplete authorizations before they result in avoidable claim denials. Assist with reconsiderations, peer-to-peer coordination, and authorization-related appeals as appropriate. Operations, Reporting & Process Improvement Maintain accurate tracking of authorization, payer, and network operational activities. Help develop and maintain SOPs, workflows, training materials, and payer reference tools. Identify recurring authorization, billing, and reimbursement problems and recommend process improvements. Support network initiatives designed to improve reimbursement and reduce preventable denials. Assist with special projects, payer implementations, and member transitions. Provide cross-functional support to Revenue Cycle, Contracting, Credentialing, and Case Management as operational needs require.

REQUIRED QUALIFICATIONS

5+ years of healthcare operations, SNF business office, billing, managed care, or revenue-cycle experience. Prior SNF Business Office Manager, Assistant Business Office Manager, senior SNF biller, managed care coordinator, or comparable experience strongly preferred. Demonstrated experience obtaining Medicare Advantage or managed care Part A SNF authorizations and recertifications. Demonstrated experience with Part B therapy authorizations. Strong understanding of SNF managed care billing and reimbursement. Working knowledge of Medicare Part A and Part B billing; Medicaid billing experience preferred. Experience working with claim denials, remittances, appeals, and payer requirements. Experience using payer portals such as Availity, Carelon, Cohere, NaviNet, or similar systems. PointClickCare and Waystar experience highly preferred. Strong problem-solving skills and ability to independently research requirements and drive issues through resolution. Strong written and verbal communication skills with the ability to work effectively with SNF Administrators, Business Office Managers, clinical teams, therapy providers, payers, and internal leadership. Certified billing/coding credential such as CPB, CPC, or comparable credential preferred, but not required.

EDUCATION / EXPERIENCE LEVEL

Five or more years of directly related experience is preferred. Relevant SNF business office, authorization, managed care, and billing experience may substitute for a specific degree requirement.

SKILL LEVEL RECOMMENDATIONS

Language Skills Read and interpret technical procedures and governmental/payer requirements; write business correspondence and procedures; present information to clients and managers. Mathematical Skills Calculate rates, percentages, adjustments, reimbursement differences, and other practical financial amounts. Reasoning Ability Define problems, collect data, establish facts, draw valid conclusions, and interpret complex technical instructions. Computer Skills Advanced working knowledge of Microsoft Outlook, Excel and Word; payer portals, clearinghouses, EHR/billing platforms, and electronic claim workflows.

Certificates / Registrations

Certified billing/coding credential (CPB, CPC, or comparable) preferred, but not required.

WORK SCHEDULE / PHYSICAL & WORK ENVIRONMENT

Full-time salaried position; regular business-office schedule with flexibility as operational needs require. Some evenings, weekends and/or Holidays will be needed on rotation to cover authorizations after hours. Physical presence in the workplace is expected based on company policy and business needs. Primarily sedentary office work with frequent computer, telephone, and electronic documentation activity; occasional lifting up to 10 pounds. Close vision and ability to adjust focus are routinely required for detailed claim and computer review. Typical professional business-office environment with moderate noise; limited travel may be required for member support or training.

Pay:

$60,000.00 - $70,000.00 per year

Benefits:

401(k) Dental insurance Employee assistance program Employee discount Health insurance Life insurance Paid time off Vision insurance

Experience:

SNF Business Office, Operations or Managed Care:

5 years (Preferred)

Prior Authorizations :

2 years (Preferred)

SNF Billing and Coding:

5 years (Preferred)

Location:

Columbus, OH 43235 (Preferred)

Work Location:

In person