Position Summary

Lead - Billing Operations Specialist is responsible for resolving un-billable claims or claim denial and underpayment issues. This position works in a computer-based billing software program and requires the ability to review denials for inconsistencies and ability to understand group plan documents and benefits language to appropriately appeal claim denials.

Job Responsibilities

• Analyzes un-billable accounts to determine why the claim went to un-billable status. Identifies root cause, determines corrective action, and resolves related issues to release claim for billing.

• Makes calls to clients, sales or other internal personnel for information requests and/or determines appropriate correspondence to send.

• Reviews response to information requests to ensure information provided is appropriate and complete to file the claim correctly.

• Codes and updates system accordingly.

• Works specialized processes for accounts missing required billing information. Researches multiple systems and examines Caris historical data to obtain missing information.

• Identifies trends and ways to help prevent billing exceptions.

• Assists as needed to perform other related duties and special projects as required.

• Accepts other duties as assigned.

Required Qualifications

• High School Diploma or equivalent required

• 5-7 years of relevant work experience in a healthcare billing/admissions/customer service environment.

• Proficient in 10 key and alpha/numeric data entry.

• Proficient in Microsoft Office Suite, specifically Word, Excel, Outlook, and general working knowledge of Internet for business use.

Preferred Qualifications

• Ability to work in a fast-past, deadline driven environment.

• Drive for Results (Service, Quality, and Continuous Improvement) – Ensure procedures and processes are in place that lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement.

• Communication – Proficient verbal and written communication skills. Willingness to share and receive information and ideas from all levels of the organization in order to achieve the desired results.

• Teamwork – Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team.

• Customer Service Focus – Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations.

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 15 pounds.

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

Other

• Willingness to work shift work and overtime is required.

• Travel Required: Rarely

Conditions of Employment: Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification.

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.