Manager, Claims Audit, Billing

About Cedar Gate Technologies

Cedar Gate Technologies, an IQVIA business, enables payers, providers, employers, and service administrators to excel at value-based care with a unified technology and services platform delivering analytics, care, and payment technology on a single data management foundation. At Cedar Gate, you’ll be part of a collaborative, innovative environment where great ideas thrive. We invest deeply in our people through ongoing training, comprehensive benefits, and a strong culture of teamwork, offering the chance to grow your skills while contributing to high impact initiatives for some of the world's most dynamic companies.

Position Summary

As the Collections Manager, Value-Based Care (VBC) Operations, you will lead the collections function for a portfolio of specialty care provider clients, ensuring strong financial performance, operational excellence, and exceptional client satisfaction. You will oversee a team of Collection Representatives, drive revenue cycle performance, and play a critical role in optimizing billing and collections processes within a growing value-based care environment.

Leveraging your expertise in medical billing, collections, and payer reimbursement methodologies, you will develop and implement best practices, establish performance metrics, and guide the team in achieving operational and financial goals. You will analyze reimbursement trends, interpret payer contracts, oversee complex collection activities, and identify opportunities to improve efficiency and outcomes across the revenue cycle.

Success in this role requires a strategic mindset, strong leadership capabilities, and the ability to collaborate effectively across departments. As a key member of the VBC Operations team, you will help shape processes, drive continuous improvement initiatives, and ensure providers receive the reimbursement they have earned while delivering a high level of service to clients and stakeholders.

Roles & Responsibilities

• Directs resolving technical or workflow-related issues causing revenue cycle deficiencies in collections and provider inquiries.
• Completes daily collection and billing KPIs audit to maintain updated knowledge on overall performance.
• Responsible for all collection, billing, and management reporting
• Monitors employee progress during orientation for achievement of competencies and goals.
• Completes annual employee reviews, including 45-day and 90-day orientation interim evaluations, in a timely manner.
• Identifies, prioritizes, and implements improved processes to increase efficiency and effectiveness of the department.
• Collaborates with other departments on identified quality and efficiency initiatives.
• Assist with developing and revising VBC policy and procedures as needed.
• Ensures adequate controls are in place to ensure that inquiries and account resolution are sustainable over time as the organization's volume grows rapidly.
• Manage the hiring, training, and development of the team to ensure the efficient operation of the function and the follow-through of company policies and procedures.

Job Location

Houston, TX

Work Arrangement

Hybrid (3 days in office, 2 remote)    

Experience / Qualifications

• 5+ years of related experience in collections and prior authorization
• Knowledge of revenue cycle management for various specialty groups, preferably with Maternity, Ortho, or Cardiovascular.
• Significant experience in making and implementing impactful decisions in complex environments where collaboration and consensus are key.
• Ability to analyze, evaluate, and develop solutions and financial needs strategically, logically, and realistically.
• Demonstrates strong leadership abilities and is perceived as confident, empathetic, and authentic.
• Possesses effective negotiation skills with both external and internal stakeholders.
• Bachelor's in healthcare, business, or a related field
• Has a thorough knowledge of industry best practices to continually enhance and improve processes related to bundles and claims.
• Fosters teamwork and strives to maximize the potential of all employees.
• Exceptional oral and written communication skills, along with strong interpersonal and customer service skills, are essential.
• Extensive familiarity with value-based care operations, including bundled payments.
• Master's Degree in a healthcare-related field
• 15+ years of related experience in collections
• 3+ years of management experience overseeing collections, billing, or revenue cycle management
• To be eligible for this position, you must reside in the same country where the job is located.

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe

IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.