Billing and Contracts Manager

Summary: The Billing & Contracts Manager is responsible for overseeing all aspects of behavioral health billing, payer contract administration, and revenue cycle performance. This role ensures accurate and compliant billing, timely collections, effective denial management, and strong payer relationships while supervising billing staff and partnering closely with clinical, administrative, and finance teams. The ideal candidate brings extensive knowledge of mental health billing regulations, payer requirements, and revenue cycle best practices.

Education:

Required: Bachelor’s degree in accounting, business, or related field of study.

Experience:

Required: A minimum of seven years accounting, billing, and contracting experience including third-party billing for behavioral health services. Experience with clearinghouses and electronic payment systems Proficient with Microsoft Office including Excel.

Abilities

Required: Ability to meet deadlines and follow through with multiple projects simultaneously. Excellent verbal and written communication skills.

Summary - Essential functions:

• Responsible for the billing and accounts receivable staff, emphasizing accurate and timely billing in accordance with the monthly closing schedule and follow-up through the collection process. Serve as billing function backup as needed to cover volume of claims and staff absences.
• Responsible for diligent collection efforts of all accounts receivable .
• Responsible for establishing and implementation of billing and collection procedures for the accounts receivable function.
• Prepare contracts that support program goals, budgets, and the Strategic Plan of the Agency
• Maintain contract list including general ledger and UFR mapping.
• Update and negotiate annual rates and maintain dialogue with key state agency and third-party insurance officials regarding new initiatives and funding changes.
• Responsible for ensuring timely and accurate billing and financial reimbursement. Responsible for analyzing trends and following up with appropriate internal and external stakeholders to troubleshoot issues and maximizing revenue and financial reimbursement.
• Collaborate with EHR and Analytics team to ensure the timely implementation of technical changes, updates to procedures, and reporting requirements in response to legal, regulatory, and payer changes.
• Work with the Chief Financial Officer to review monthly financial statements. Prepare monthly Accounts Receivable reports for the Finance Committee.
• Perform other duties as assigned

Details - Essential Functions:

Billing, Coding & Claims Management

• Oversee accurate and timely preparation, review, and submission of claims to commercial, Mass Health, and other payers.
• Personally prepare and submit claims as needed during high-volume periods, staff absences, or vacancies.
• Ensure codes for behavioral health services, including individual and group therapy, psychiatric evaluations, medication management, case management, and telehealth.
• Identify and correct coding or documentation issues in collaboration with clinical teams.
• Maintain expertise in behavioral health billing nuances, including no-shows, authorization-driven services, and payer-specific requirements.

Contracts & Payer ManagementManage payer contracts, including fee schedules, authorization requirements, and billing rules.

• Serve as the primary point of contact with insurance companies regarding billing, payment, and contract-related inquiries.
• Monitor payer performance and escalate issues related to underpayments, delays, or systemic denials.

Payment Posting, Reconciliation & Accounts Receivable

• Ensure accurate posting and reconciliation of insurance and patient payments.
• Monitor accounts receivable aging and lead systematic follow-up on unpaid claims.
• Investigate and resolve payment discrepancies, underpayments, and zero-pay claims.
• Coordinate patient billing, statements, and collections for deductibles, co-pays, and outstanding balances.

Denial Management & Appeals

• Review and analyze denied claims and determine appropriate corrective actions.
• Prepare, submit, and track appeals, particularly those related to medical necessity, authorization limits, and documentation requirements.
• Identify denial trends and work with clinical and administrative teams to track and monitor recurrence.

Compliance & Regulatory Oversight

• Ensure billing and contracting practices comply with federal, state, and payer regulations,
• Serve as the Walker contact on behavioral health billing rules and regulatory changes.
• Support internal and external audits and maintain required documentation.
• vise, train, and support billing staff to ensure consistent performance and compliance.
• Establish efficient workflows and internal controls across billing and contracts functions.
• Conduct performance reviews and provide coaching and professional development.

Financial Reporting & Analysis

• Monitor and report key revenue cycle metrics, including collection rates, days in A/R, denial rates, and payer trends.
• Provide regular reporting and insights to senior leadership and the finance team.
• Support revenue forecasting and cash flow planning related to behavioral health services.

Systems & Process Improvement

• Oversee billing systems and EHR functionality related to claims, payments, and reporting.
• Coordinate system updates and troubleshoot issues in partnership with IT.
• Train staff on new system features, payer changes, and process improvements.

Education and Experience

Required

• Bachelor’s degree in healthcare administration, finance, business, or a related field (or equivalent experience).
• Minimum of 5 years of experience in behavioral health billing and revenue cycle management.
• Demonstrated knowledge of mental health billing codes (ICD-10, CPT, HCPCS) and payer requirements.
• Experience managing denials, appeals, and payer communications.
• Strong understanding of healthcare compliance and regulatory requirements.

Preferred

• Supervisory or management experience in a billing or revenue cycle function.
• Experience managing payer contracts and fee schedules.
• Experience with behavioral health EHR and billing systems.

Skills & Competencies

• Strong attention to detail and analytical skills
• Ability to manage multiple priorities and deadlines
• Clear and professional communication with staff, payers, clinicians, and patients
• Collaborative, solutions-oriented leadership style
• Commitment to accuracy, compliance, and continuous improvement

Supervision to be received: Chief Financial Officer

Supervision to be exercised: Billing Staff and Consultants