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 improve the lives and well-being of their patients and residents. Our teams utilize insights and analytics to drive better health outcomes for our partnered post-acute and senior living communities while providing them with flexible service options.

Symbria's Core Values drive the way we partner with those clients, their patients and residents and the way our diverse employee-owners work together:

• Integrity - Honest, Fairness and ethics
• Compassion - Commitment to serving seniors
• Stewardship - Maximizing mission and margin
• Innovation - Striving to enhance our value to your organization
• Teamwork - Working together unselfishly toward goals

As an employee-owner, Symbria's success becomes your success. In addition, we provide:

• Competitive pay, aligned with market guidelines
• Full Benefits Package, including very generous paid time off plans
• Professional liability coverage
• 100% employer-funded ESOP retirement plan
• 401(k) and Roth(k) plans
• Continuing education
• Credit union membership

All applicants will be afforded equal opportunity without discrimination because of race, color, religion, sex, sexual orientation, marital status, order of protection status, national origin or ancestry, citizenship status, age, physical or mental disability unrelated to ability, military status or an unfavorable discharge from military service.