Billing & Population Health Manager

Job Title:Population Health and Billing Manager
Department: Primary Care Practice
Reports To: Practice Administrator / Medical Director

Position Summary:

The Population Health and Billing Manager is responsible for overseeing and optimizing the primary care practice’s population health initiatives and billing operations. This dual role ensures alignment between quality care delivery, value-based care goals, and financial performance. The manager leads efforts in patient outreach, care coordination, data reporting, and revenue cycle management to enhance clinical outcomes and maximize reimbursements.

Key Responsibilities:

Population Health Management:

• Develop, implement, and manage population health programs to improve patient outcomes and meet value-based care metrics (e.g., HEDIS, ACO, PCMH, MIPS).
• Utilize data analytics and EHR tools to identify care gaps, high-risk patients, and preventive care opportunities.
• Coordinate with clinical teams to support care coordination, transitions of care, chronic disease management, and patient engagement.
• Monitor and report on quality performance metrics, patient registries, and risk stratification reports.
• Collaborate with payers on value-based contracts and reporting requirements.

Billing and Revenue Cycle Management:

• Oversee daily billing operations, including charge capture, coding, claims submission, payment posting, and accounts receivable management.
• Ensure compliance with federal, state, and payer billing regulations and guidelines (e.g., CMS, HIPAA).
• Work closely with clinical and administrative teams to ensure accurate documentation and coding (ICD-10, CPT, HCPCS).
• Monitor denials and implement strategies to reduce claim rejections and improve reimbursement.
• Conduct internal audits and implement training to improve billing accuracy and efficiency.

Leadership and Compliance:

• Supervise and mentor billing and care coordination staff; facilitate cross-functional collaboration.
• Stay current with regulatory and industry changes in healthcare billing and population health.
• Develop and implement policies and procedures to support efficient and compliant workflows.
• Prepare reports for leadership on financial performance, population health outcomes, and improvement opportunities.

Qualifications:

Education & Experience:

• Bachelor’s degree in healthcare administration, Public Health, Business, or related field preferred but not required with appropriate experience
• Minimum 3–5 years of experience in medical billing and/or population health management, preferably in a primary care or outpatient setting.
• Experience with value-based care programs (e.g., ACOs, PCMH, MSSP) is highly preferred.

Skills & Competencies:

• Strong understanding of healthcare billing, collections, and reimbursement processes.
• Proficiency in EHR systems (eClinicalWorks) and data analytics tools.
• Knowledge of population health metrics, care gap analysis, and patient engagement strategies.
• Excellent leadership, communication, and organizational skills.
• Ability to manage multiple priorities in a fast-paced clinical environment.

Work Environment:

• Full-time position based in a clinical/administrative office setting.

Contact Information