Billing Operations Manager overseeing the Eligibility function within Billing Operations team at Caris Life Sciences. Responsible for insurance verification, leadership, and process improvements.
About the role
- Billing Specialist at Headspace ensuring timely and accurate insurance A/R resolution with project execution and problem-solving responsibilities.
Responsibilities
- Work assigned worklists of complex and high-risk accounts, meeting productivity and quality targets while driving timely A/R resolution.
- Own key insurance collections workflows (e.g., recoupments) and billing / coding accuracy processes (e.g. coding and billing quality audits) end-to-end, driving complete, accurate, and SLA-compliant execution.
- Resolve claim issues across rejections, denials, and underpayments through payer portal review, payer outreach, documentation review, and escalation pathways.
- Research, review, and resolve exceptions and escalations surfaced by teammates and cross-functional partners, bringing issues to closure with strong documentation.
- Maintain high-quality claim notes and documentation standards to ensure auditability, continuity, and efficient handoffs.
- Conduct special projects (e.g. targeted payer issue review, A/R clean-up, etc.) and provide "SWAT" support for high-risk billing areas when needed to reduce write-offs and address aging risk.
- Support weekly / monthly reporting and reconciliation activities and ensure accurate tracking of collections progress and payer behavior.
- Assist with monitoring workload and KPIs, and contribute to the design and implementation of system / process changes and improvement initiatives.
- Contribute to productivity and quality reporting processes, flagging gaps, trends, and opportunities to improve operational performance.
- Partner in delivering team training and strengthening SOP documentation to drive standardized, high-quality execution.
- Actively identify and advance AI and automation opportunities within collections workflows, partnering on pilots and driving adoption to improve efficiency and accuracy.
- Conduct ongoing coding and billing accuracy reviews, implement corrective actions as needed, and partner with Clinical and QA teams to identify retraining and performance improvement opportunities.
- Identify trending claim issues and root causes (rejections, denials, underpayments) and recommend practical remediation strategies to improve collections performance.
- Recommend solutions to enhance existing workflows and leverage available resources to overcome unforeseen issues (e.g., payer constraints, system limitations, unclear routing).
- Prioritize between competing work and project deliverables with sound judgment, communicating assumptions and clarifying requirements up front to minimize rework.
- Identify opportunities to standardize, automate, and reduce manual processes across collections workflows; support testing and adoption of improvements.
- Partner with Product and Engineering on testing and validation of RCM workflow enhancements (e.g., UAT support, requirements feedback) when needed.
- Work cross-functionally with internal teams (e.g., Clinical, Provider Ops, Client/Account partners, Member Support, etc.) to implement and optimize workflows for new and existing health plans, clients, and members.
Requirements
- 5+ years of Revenue Cycle Management experience with strong knowledge of medical claims and health plan/EAP rules.
- Strong claims follow-up skills across denials, rejections, and underpayments; ability to independently drive resolution to closure.
- Strong root-cause problem solving and attention to detail; high bar for accuracy and documentation.
- Ability to prioritize effectively across competing work and communicate assumptions/needs early to reduce rework and unblock progress.
- Proficiency in Excel and comfort using data to support reporting, reconciliation, and operational decision-making.
- Strong communication and interpersonal skills; ability to collaborate cross-functionally in a fast-paced environment.
Benefits
- base salary
- stock awards
- comprehensive healthcare coverage
- monthly wellness stipend
- retirement savings match
- lifetime Headspace membership
- generous parental leave
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