Manager, Clinical Bill Review (Healthcare)

TL;DR

Manager, Clinical Bill Review (Healthcare): Lead the clinical bill review function and shape strategic direction with an accent on quality, productivity, financial outcomes, and compliance. Focus on establishing performance frameworks, optimizing workflows, driving data-informed improvements, and leading workforce strategy.

Location: Fully remote, must be US based to comply with company policies such as HIPAA. Quiet workspace, reliable internet, VPN/security protocols required.

Company

Platform simplifying healthcare for employers, payers, providers, and members to reduce costs, improve quality, and elevate the experience.

What you will do

• Own clinical bill review function, setting strategic direction aligned with objectives and growth.
• Oversee contract lifecycle management system for data integrity and scalability.
• Establish performance frameworks including KPIs, productivity, and quality benchmarks.
• Drive operational effectiveness, scalability, and financial impact through initiatives.
• Lead workforce strategy, capacity planning, and resource allocation.
• Leverage data analytics for trends, optimizations, and actionable strategies.
• Ensure compliance, manage escalations, and deliver executive reporting.

Requirements

• 8+ years in clinical bill review, utilization review, medical cost containment, or related healthcare environment
• 2+ years progressive leadership with direct team management
• Experience leading operations for quality, productivity, financial outcomes.
• Developing performance frameworks, KPIs, SLAs, quality assurance.
• Analyzing data, workflow optimization, system implementations.
• Handling escalations, cross-functional collaboration, client-facing exposure.

Nice to have

• Bachelor’s degree in Nursing, Healthcare Administration, or related field.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent.

Culture & Benefits

• Generously subsidized Medical, Dental, Vision insurance via own products.
• HSA, FSA, DCFSA spending accounts; 401K with match and vesting.
• Generous PTO including vacation, sick leave, holidays; paid maternity/paternity leave.
• Flexible remote environment, Employee Assistance Program, pet insurance.
• Discounts on phones, rentals, computers; community giveback PTO.