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Manager - Billing Operations Specialist

2 months ago

Irving, Texas, United States Caris Life Sciences Full time
Job Summary

Caris Life Sciences is seeking a highly skilled Manager - Billing Operations to oversee the day-to-day operations for a defined payor group. This role will be responsible for managing billing processes, resolving front-end rejections, submitting medical necessity appeals, and responding to medical records requests from payors.

Key Responsibilities
  • Manage a team with focused responsibilities resolving front-end rejection, submitting medical necessity appeals, and responding to medical records requests from regional payors.
  • Oversee daily and weekly production and quality to ensure the team is exceeding expectations.
  • Provide accounts receivable management by monitoring and following up on unpaid claims, denied claims, and billing discrepancies.
  • Prepare regular operational reports to track department performance, identify trends, and recommend improvements.
  • Hire, train, and develop team members.
  • Provide expert technical guidance to functional and cross-functional efforts that independently address complex challenges to facilitate decision-making.
  • Draft and revise Standard Operating Procedures and training materials as required.
  • Assist as needed to perform other related duties and special projects as required.
Requirements
  • High School degree or equivalent required.
  • 5+ years of experience in medical billing with at least 3 years' experience in a supervisory or management role.
  • Demonstrated leadership and interpersonal skills.
  • Understanding of HIPAA and importance of privacy of patient data.
  • Experience working with Medicare Advantage plans is a plus.
  • Experience with Xifin is a plus.
  • Understanding of CPT, ICD-10, and HCPCS coding, payor regulations, and revenue cycle management.
  • Ability to motivate and engage staff in meeting/exceeding performance goals.
  • Demonstrated track record in managing change.
  • Demonstrated ability to lead and motivate a team in a fast-paced environment.
  • Ability to think creatively and initiate new ideas or solutions to business issues.
Preferred Qualifications
  • Bachelor's preferred.
  • Experience in a laboratory role is preferred.
Conditions of Employment

Individuals must successfully complete the pre-employment process, which includes criminal background check, drug screening, and reference verification.