Manager, Billing & Operations
About The Position
The Manager, Billing & Operations supervises pharmacy and medical claims processing at Reliance Rx and manages the billing and medical operations teams. The role monitors daily workflow and phone metrics, audits billing queues to ensure accurate and timely processing, assesses claims-system upgrades and enhancements, and promotes best business practices. The manager oversees pharmacy NCPDP claims and medical claims, including 837 file development and submission, timeliness, denial correction and resubmission, and payment accuracy. In collaboration with internal departments, payors, and external stakeholders, the manager optimizes revenue cycle performance, resolves complex billing issues, maintains contractual and regulatory compliance, and drives operational excellence. The position 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.
Requirements
- Bachelor’s degree required, or an additional four years of experience 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.
- Strong organizational, process, and time-management skills, with the ability to handle multiple tasks.
- Demonstrated alignment with Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive.
Nice To Haves
- Specialty pharmacy and 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.
- Address escalated billing issues, perform root-cause analysis of billing discrepancies, and manage associate follow-up, retraining, and disciplinary action when needed.
- Interpret NCPDP and medical claim responses, resolve rejections, and identify overpayments, underpayments, and other reimbursement discrepancies.
- Monitor billing for regulatory and payor compliance, including Medicare and Medicaid requirements, service-level agreements, and shipping timelines.
- Observe and review billing practices, provide coaching, and manage and develop the Billing Specialist team while monitoring productivity and performance metrics.
- Oversee patient and insurance accounts receivable from claim submission and payment posting through denial resolution.
- Monitor reimbursement trends, accounts receivable, denial management, and aging balances; identify causes of billing errors 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 support efficiency and compliance; facilitate training as needed.
- Lead the 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.
- 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.
Benefits
- Full range of benefits.
- Generous paid time off.
- Associates may be eligible for a scorecard incentive.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
