Remote Utilization Review Nurse Jobs in Springfield, MA

Join Us as an Outpatient Business Office Manager!

$10,000 Sign on bonus available!

Full time 40 hours, Monday - Friday onsite in Holyoke, MA

The Outpatient Billing Office Manager is responsible for the daily management and oversight of all outpatient billing, collections, accounts receivable, and revenue cycle activities for behavioral health and substance use disorder (SUD) services. This is a hands-on leadership role responsible for performing billing functions while supervising billing, collections, and cash posting staff to ensure timely and accurate reimbursement. The Manager is accountable for achieving cash collection, accounts receivable, and productivity goals established by the Director of Revenue Cycle.

This position works collaboratively with clinical leadership, admissions, utilization review, finance, and compliance to ensure accurate billing, regulatory compliance, and optimal reimbursement.

As the Outpatient Business Office Manager you will:

• Manage all outpatient revenue cycle operations including billing, claims submission, payment posting, collections, denials, and accounts receivable follow-up.
• Perform and oversee billing for behavioral health and SUD outpatient services including:
  • Partial Hospitalization Program (PHP)
  • Intensive Outpatient Program (IOP)
  • Individual, Group, and Family Counseling
  • Medication Management
  • Daily dosing and medication-assisted treatment (MAT) services
• Maintain comprehensive knowledge of CPT, HCPCS, ICD-10, revenue codes, modifiers, National Correct Coding Initiative (NCCI) edits, bundled services, and payer-specific billing requirements.
• Demonstrate proficiency using Massachusetts Virtual Gateway, including eligibility verification, Unit Rate and Cost Reimbursement billing, Medicaid eligibility, and MassHealth reimbursement processes.
• Ensure timely and accurate claim submission to commercial insurance, Medicare, Medicaid/MassHealth, Managed Medicaid, and other third-party payers.
• Investigate and resolve denied or rejected claims while identifying root causes and implementing corrective actions.
• Monitor accounts receivable aging, identify collection trends, and implement strategies to improve cash collections and reduce outstanding receivables.
• Meet departmental goals for cash collections, clean claim rates, denial management, and AR days.
• Supervise, train, mentor, and evaluate billing office personnel, including billers, collectors, and cash posting staff.
• Assist patients and families with Medicaid Pending applications and coordinate with state agencies to secure appropriate coverage.
• Maintain accurate financial records including receipts, payment posting, deposits, and reconciliation while ensuring proper segregation of duties and internal controls.
• Work closely with admissions, intake, utilization review, nursing, finance, and clinical departments to ensure complete and accurate documentation supporting reimbursement.
• Coordinate daily, weekly, and monthly census reconciliation between clinical operations and billing.
• Review payer contracts and communicate billing requirements, authorization requirements, patient financial responsibility, copays, deductibles, and coinsurance expectations.
• Maintain compliance with federal, state, and payer regulations including HIPAA, CMS, MassHealth, Department of Mental Health (DMH), Bureau of Substance Addiction Services (BSAS), and other applicable regulatory agencies.
• Prepare routine productivity, billing, collections, denial, and accounts receivable reports for Revenue Cycle leadership.
• Participate in audits, compliance reviews, and process improvement initiatives.
• Perform other duties as assigned.

To be successful in the Outpatient Business Office Manager role, candidates should meet the following education, licensure, and experience requirements:

• Associate’s degree required; Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field preferred.
• Minimum five (5) years of progressively responsible healthcare billing and revenue cycle experience.
• Minimum two (2) years of supervisory or management experience.
• Experience billing behavioral health, psychiatric, and/or substance use disorder outpatient services required.
• Strong knowledge of MassHealth, Medicare, Medicaid, commercial insurance, and managed care billing.
• Experience with Massachusetts Virtual Gateway strongly preferred.
• Knowledge of Unit Rate and Cost Reimbursement billing preferred.
• Experience with electronic health records and billing systems (Netsmart, WellSky, Avatar, Credible, or similar) preferred.
• Advanced Microsoft Excel and reporting skills.
• Excellent analytical, organizational, problem-solving, and communication skills.
• Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or other revenue cycle certification.
• Experience with behavioral health payer contracting and reimbursement.
• Knowledge of denial management, revenue integrity, and performance improvement methodologies.

When you join the growing MiraVista team as the Outpatient Business Office Manager, you’ll receive:

• Medical, Dental, and Vision

• 401(k) match

• Employer paid long term disability (LTD)

• Employer paid life and AD&D Insurance

• Generous Paid Time Off

• Flexible Spending Account

• Tuition Reimbursement

Pay Range

Compensation will be determined based on the candidate’s relevant experience.

$75,000 - $85,000

MiraVista is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.