Director of Billing Services - Long Term Care

Overview

 

 

✨Symbria Rx is seeking a highly skilled and dedicated Director of Billing for Long Term Care to join our EMPLOYEE-OWNED TEAM!✨

 

POSITION SUMMARY

The Director of Billing plays a critical leadership role in managing all aspects of pharmacy billing including Medicare Part A, Managed Care, Medicare Part D, commercial and other third-party payers.This individual is responsible for operational oversight of claim adjudication, billing and reimbursement activities, leading a team of billing professionals, ensuring compliance with payer requirements, vaccination clinic billing, and driving process improvement initiatives.

This position requires a seasoned billing professional who can make sound decisions, build and lead teams, deliver high-quality customer support, and streamline workflows for maximum efficiency and effectiveness. The ideal candidate is dependable, dedicated, and aligned with the organization's mission to deliver exceptional service to long-term care partners.

 

 

 

Responsibilities

• Lead, manage and hold accountable the day-to-day operations of the pharmacy billing department and team members.
• Oversee the full monthly billing cycle for Med A, Part D, commercial plans, and Private pay to ensure timely and accurate delivery of invoices
• Oversee vaccine clinic billing to ensure accurate and timely submission
• Proactively address and resolve billing discrepancies, payer denials, and appeals both internally and externally.
• Act as liaison for obtaining third-party payer contracts
• Serve as the escalation point for internal staff and external client billing issues.
• Ensure departmental compliance with all payer requirements, CMS regulations, and company standards.
• Provide oversight and guidance to Pharmacy Audit Specialist
• Manages process of entering pricing into pharmacy information system
• Work with Pharmacy Billing Manager to establish metrics and ensure metrics are measured, monitored, and effectively utilized to hold employees accountable,
• Build, mentor, and retain a high-performing team.
• Train new staff and implement cross-training programs to increase department flexibility.
• Continuously assess and refine workflows for efficiency, scalability, and cost-effectiveness.
• Develop, track, and report KPIs and quality metrics; use data to drive accountability and performance improvements.
• Collaborate cross-functionally with operations, clinical, IT, and finance to align goals and improve communication.
• Identify gaps in current processes and implement solutions with a focus on continuous quality improvement.
• Hold team members accountable to established protocols and intervene when deviation from process occurs.
• Participate in strategic planning and contribute to departmental goals, budgeting, and forecasting.
• Perform other duties as assigned.

Qualifications

 

• High school diploma or equivalent required; Associate or Bachelor’s degree in Business, Accounting, or related field preferred.
• Minimum of five (5) years' experience in Long Term Care pharmacy billing with a strong emphasis on Medicare Part A, Medicare Part D, and private insurance reimbursement.
• Minimum of three (3) years of supervisory or managerial experience in a healthcare billing environment.
• Demonstrated ability to lead teams, develop staff, and manage department performance metrics.
• Ability to train, mentor, coach, and delegate while holding staff accountable.
• Strong working knowledge of pharmacy billing platforms, eHRs, and payer portals.
• Exceptional problem-solving and decision-making skills with a keen eye for process improvement and efficiency.
• Outstanding customer service, interpersonal, and communication skills—both written and verbal.
• Proficiency in Microsoft Office applications

 

PREFFERED QUALIFICATIONS

• Experience with ticketing systems (Jira, FreshDesk, ZenDesk, etc.).
• Proficiency in Microsoft Excel (including formulas, filters, and pivot tables).
• Knowledge of Medicare Part D & B billing

 

DIRECT REPORTS

• Pharmacy Billing Manager
• Pharmacy/ Third Party Audit specialist
• Adjudication Technicians

Why work for us?

 

At Symbria our employees act like owners – because we are owners!  As one of the few 100% employee-owned healthcare providers, our focus remains on delivering best-in-class services within our Pharmacy, Rehabilitation and Well-Being operations, which allows our clients to impro