Billing Operations Manager

Role overview

The Billing Operations Manager is a pivotal role at Upheal helping Upheal customers implement insurance billing features within the Upheal product. This is a fantastic time to join Upheal as we launch both insurance billing run by providers and managed billing where Upheal offers billing services to our customers under their own NPI. This role is involved in the day to day support of our customers billing operations with the opportunity to grow into leading a team.

Key Responsibilities

1. Insurance Enrollment & Clearinghouse Setup
   1. Provider Onboarding: Guide clinicians through the process of enrolling in Upheal’s insurance billing services and linking their existing insurance panels to Upheal's system.
   2. Transaction Enrollment via Stedi: Manage electronic data interchange (EDI) and electronic remittance advice (ERA) transaction enrollments using Stedi to ensure seamless claim routing and payment posting.
   3. Eligibility Verification: Assist customers in verifying patient insurance eligibility and benefits prior to appointments to prevent claim rejections.
2. Customer Support & Advisory
   1. Billing Helpdesk: Act as the primary subject matter expert and point of contact for Upheal customers regarding billing questions, claim statuses, and payer policies.
   2. Patient Billing Guidance: Support providers in understanding and navigating patient statements and patient-responsibility collections.
3. Managed Billing Execution (Hands-on Billing)
   1. Claim Submission: Prepare, review, and submit clean insurance claims (837P) to commercial and government payers on behalf of Upheal customers.
   2. Modern Clearinghouse Management: Monitor daily Stedi portal/clearinghouse reports, analyze 277CA claim acknowledgments, catch formatting errors early, and resolve rejected claims immediately.
   3. Denial & Appeals Management: Investigate claim denials, draft and file timely appeals, and aggressively pursue outstanding accounts receivable (A/R) to ensure providers get paid.
4. Process Building & Product Collaboration
   1. Build the Billing Playbook: Design and document standard operating procedures (SOPs) for Upheal’s managed billing workflow from scratch.
   2. Product Feedback Loop: Work closely with the product and engineering teams to share insights on how Upheal’s software interacts with Stedi and how to better automate billing workflows for users.
   3. Performance Tracking: Establish and monitor key billing metrics, such as Days in A/R and clean claim rates, to demonstrate the ROI of Upheal's billing service.

Preferred Qualifications

‍• Experience: 3+ years of experience in mental/behavioral health insurance billing and revenue cycle management (RCM)
• Clearinghouse Expertise: Strong familiarity with modern clearinghouse platforms, specifically Stedi (highly preferred), or traditional platforms (e.g., Change Healthcare, Waystar, Availity) with a strong desire to work in a modern, API-driven UI.
• Technical Aptitude: Comfortable working in a fast-paced SaaS environment. Have a strong understanding of ICD-10 and CPT codes (ideally at least a CPC certification) and  understand terms like EDI, ERA, 837/835 files, and enjoy helping product teams build better automation.
• Mindset: A builder mentality. You are excited to be the "first hire" doing the execution today while creating the playbook for the team tomorrow.