Manager, Billing & Operations

Independent Health Association•Buffalo, NY

8d•Hybrid

About The Position

The Manager-Billing and Medical Operations supervises and manages pharmacy and medical claims processing at Reliance Rx and leads the billing and medical operations teams. The manager monitors daily workflow and phone metrics, audits billing queues for accurate and timely processing, assesses claims-processing system upgrades, and promotes best business practices. The role oversees pharmacy NCPDP claims and medical claims processing, including 837 file development and submission, denial corrections and resubmissions, timeliness, and payment accuracy. The manager works with payors, internal departments, and external stakeholders to improve revenue-cycle performance, resolve complex billing issues, maintain contractual and regulatory compliance, and drive operational excellence. The role is accountable for reimbursement accuracy, accounts receivable oversight, and continuous improvement of billing processes and systems. This is a hybrid position requiring onsite attendance at the Williamsville location. Immigration or work visa sponsorship will not be provided. Hiring compensation is $76,500–$95,000 annually; compensation may vary based on skills, education, location, and experience. Associates may be eligible for a scorecard incentive, a full range of benefits, and generous paid time off.

Requirements

Bachelor’s degree required; an additional four years of experience may be considered in lieu of a degree.
Five years of experience with third-party claims billing, patient collections, or high-volume pharmacy, including two years in specialty pharmacy, specialty infusion, or a related business.
Two years of progressive leadership or management responsibility.
Strong leadership, coaching, and mentoring skills, including the ability to address and resolve associate issues objectively and promptly.
Excellent written and verbal communication and problem-solving skills, including the ability to absorb new concepts and serve as a role model or mentor to billing specialists.
Excellent organizational, process, and time-management skills, with the ability to handle multiple tasks.
Demonstrated examples of Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive.

Nice To Haves

Specialty pharmacy experience.
Copay assistance or foundation billing experience.
Medical billing and 837 claim transaction experience.

Responsibilities

Oversee NCPDP claims processing, medical claims submission via 837 and CMS1500, copay assistance billing, and paper claims submission when necessary.
Serve as the subject matter expert on pharmacy versus medical benefits and NCPDP versus medical claims, and train the team on their differences.
Resolve billing issues, review escalations, conduct root-cause analysis of billing discrepancies, and establish best billing practices.
Provide associate follow-up, retraining, and disciplinary action when needed.
Resolve NCPDP and medical claim responses, including rejections, and identify reimbursement discrepancies from paid claim responses.
Monitor regulatory billing requirements, including Medicare and Medicaid, and ensure payor compliance with service-level agreements and shipping timelines.
Observe and review billing practices, coach staff, manage and develop the Billing Specialist team, and monitor productivity and performance metrics.
Oversee patient and insurance accounts receivable, including workflow from claim submission and payment posting through denial resolution.
Monitor reimbursement trends, patient and insurance receivables, denial management, and aging balances; identify causes of discrepancies and implement corrective action plans.
Oversee quality assurance audits for compliance with payer contracts and internal standards.
Evaluate billing system enhancements and implement process improvements to improve efficiency and compliance; facilitate training as needed.
Lead submission, maintenance, and management of 837 files and work with payors on implementation and testing.
Manage Medical Benefit Orders administered by providers and clinics, ensure orders are received before scheduled appointments, and work with offices on best practices.
Partner with Finance, Infusion, and Account Management to resolve billing discrepancies and improve revenue-cycle performance and management.
Work with infusion, clinical account pharmacists, and regional sales executives on strategic business development to increase service offerings and maintain service excellence.
Collaborate to achieve departmental goals, quality metrics, and organizational objectives.