Senior Billing Operations Specialist

GRAIL is a healthcare company whose mission is to detect cancer early, when it can be cured. GRAIL is focused on alleviating the global burden of cancer by developing pioneering technology to detect and identify multiple deadly cancer types early. The company is using the power of next-generation sequencing, population-scale clinical studies, and state-of-the-art computer science and data science to enhance the scientific understanding of cancer biology, and to develop its multi-cancer early detection blood test. GRAIL is headquartered in Menlo Park, CA with locations in Washington, D.C., North Carolina, and the United Kingdom. It is supported by leading global investors and pharmaceutical, technology, and healthcare companies. For more information, please visit www.grail.com.

The Senior Billing Operations Specialist will be responsible for planning, organizing and executing day to day billing and reimbursement operations (patient, client and third party payors) in support of GRAIL, Inc.' s CLIA laboratory testing services.

The successful candidate will have meaningful experience leading medical billing and collections while interacting directly with external customers including employer groups, medical institutions and patients. The Senior Billing Operations Specialist will serve as a liaison to our third party billing partner and our management team while working closely with the Clinical Laboratory, Marketing, Sales, Finance and the Customer Service groups to ensure quality, accuracy and efficiencies within billing and reimbursement processes.

You will (Billing Operations):

• Act as a liaison between GRAIL, Inc. management and our billing partner.
• Management and creation of new client accounts (including but not limited master files, pricing, test codes, client portal access) in coordination with Legal, Customer Service and our third party billing partner.
• Ensure the accuracy of data from accessioning through the submission of patient statements, client invoices and third party claim submission.
• Management and processing of GRAIL, Inc. assigned daily billing work queues.
• Collection of missing and/or invalid information needed to accurately submit insurance claims, patient and client bills (i.e. client and patient demographics; insurance information).
• Management and processing of patient and direct client bills as well as timely and effective collection of outstanding patient and direct client bill A/R.
• Collection of medical records and letters of medical necessity in support of third party payer appeals.
• Resolution of credit balances, overpayments and refund requests in coordination with our billing partner and Finance department.
• Support billing programs.
• Assist billing partner in the completion and processing of provider EDI (ERA/EFT) enrollment applications.
• Respond to escalated inquiries from external (i.e. physician's office and/or patient) and internal (Key/National Account Managers) customers regarding bills or EOB's received as well as general and required billing policies.

You Will (Performance Management):

• Provide analytical support to identify patterns, trends, contract payment variance and opportunities for improvement through analysis and the monitoring of metrics in key performance areas to patient, client and third party payor reimbursement, payor specific behavior and billing compliance. Lead the charge collect reconciliation process between our internal systems and that of our billing partner.
• Assist in development and implementation of strategic plans focused on improvement in high priority and key performance indicators.
• Primary resource for ad hoc analysis requests and priority special projects.

Your background should include:

• Typically a minimum of 5+ years of related experience with a Bachelor's degree or equivalent experience
• Ability to lead multiple tasks to completion in a dynamic setting.
• Strong attention to detail.
• Demonstrated success in engaging with both internal and external customers.
• Effective and professional communication skills and the ability to navigate meaningful questions and resolve complex problems.
• Excellent written communication skills are required, including technical computer proficiency (Google Docs, Google Sheets etc).
• Flexible, team-player with ability to develop standard methodologies for procedures on new assignments.
• Experience in working in a remote setting.
• Ability to work independently and handle tasks a multifaceted and fast paced environment.
• Significant experience with billing operations is needed, shown knowledge of billing compliance, experience with XIFIN RPM and experience with medical laboratory billing is helpful.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

GRAIL, Inc. and its affiliates and subsidiaries ("GRAIL") does not accept any liability for fees for resumes from recruiters or employment agencies ("Agency"), without a binding, written recruitment agreement between GRAIL and Agency describing the services and specific job openings ("Agreement"). GRAIL may consider any candidate for whom an Agency has submitted an unsolicited resume and explicitly reserves the right to hire those candidate(s) without any financial obligation to the Agency, unless an Agreement is in place. Any email or verbal contacts with any person within GRAIL is inadequate to create a binding agreement. Agencies without an Agreement are requested not to contact any hiring managers of GRAIL with recruiting inquiries or resumes. Agencies interested in partnering with GRAIL may contact GRAIL's HR Department through our Customer Service team .