Position Summary

We are seeking an experienced and effective Credit & Payment Director to oversee assigned processes within the billing operations group. Key areas of responsibility include secondary payer and patient billing, cash applications, and payer audit responses. This role requires strong leadership skills, analytical abilities, extensive knowledge of healthcare billing practices, and a commitment to process improvements.

Job Responsibilities

• Lead and manage billing and appeals specialists and support staff, providing guidance, training, and performance feedback as needed.

• Provide leadership to the cash applications, secondary claims, and patient billing teams.

• Oversee the processing of secondary claims and patient invoices and identify trends, patterns, and opportunities for improvement.

• Manage employees and vendors engaged in patient billing activities to include patient billers, outsourced patient invoicing print vendor, and collection agencies. Manage escalated patient billing related calls and correspondence.

• Monitor the status of secondary claims, including denials, rejections, and pending payments, and follow up as needed to resolve issues and ensure timely reimbursement.

• Provide oversight to the team responsible for posting payments, adjustments, denials, and transactions in the billing system.

• Identify and correct posting errors and underpayments; research and resolve payment posting discrepancies.

• Generate and distribute e reports summarizing payment posting activities, account reconciliation, and credit balances.

• Verify the validity of refund requests by comparing payment records, billing statements, and documentation to determine if overpayment exists.

• Effectively appeal/respond to invalid refund requests, SIU documentation requests, and payer audits.

• Develop and implement policies, procedures, and workflows with an eye towards continuous improvement.

• Ensure compliance with all relevant regulations, including HIPAA, CMS guidelines, and payer requirements, and implement strategies to minimize denials and optimize reimbursement.

• Collaborate with other departments resolve billing-related issues and streamline processes.

• Monitor key performance indicators (KPIs) related to productivity and develop strategies to achieve departmental goals.

Required Qualifications

• Minimum of 5 years of experience in medical billing/revenue operations with at least 2 years in a supervisory or managerial role.

• In-depth knowledge of medical coding guidelines, regulations, and compliance standards, including ICD-10, CPT, and HCPCS.

• Strong leadership, communication, and interpersonal skills, with the ability to effectively manage a team and collaborate with internal and external stakeholders.

• Excellent analytical and problem-solving abilities, with a focus on accuracy, attention to detail, and process improvement.

• Ability to adapt to changing priorities and work effectively in a fast-paced, dynamic environment.

• Commitment to maintaining confidentiality and integrity in handling sensitive patient information.

• Familiarity with healthcare reimbursement methodologies and revenue cycle management principles.

• Proficiency in using billing software and electronic health record (EHR) systems (Xifin preferred).

• Conditions of Employment: Individuals must successfully complete pre-employment process, which includes criminal background check, drug screening, and reference verification.

Preferred Qualifications

• Bachelor's degree in healthcare administration, business administration, or a related field preferred.

• Medical billing/revenue operations experience in an Oncology or Laboratory setting.

Physical Demands

• Must possess ability to sit and/or stand for long periods of time.

• Must possess ability to perform repetitive motion.

• Ability to lift up to 25 pounds.

• Majority of work is performed in a desk/cubicle environment.

Training

• All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.

Other

• Willingness to work shift work and overtime is required.

• Travel Required: Rarely

• Weekends/Evenings/Holidays: No

This job description reflects management’s assignment of essential functions. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

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