CareDx, Inc. is a leading precision medicine solutions company focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients and caregivers. CareDx offers products, testing services, and digital healthcare solutions along the pre- and post-transplant patient journey, and is the leading provider of genomics-based information for transplant patients.
The Senior Manager is responsible for overseeing the process from claim creation, claims follow up, trouble shooting EOBs, appealing non covered tsting as well as low payments, and driving positive coverage determinations through external appeals. The Senior manager also promotes efficiency and assists the revenue cycle department in resolving revenue cycle problems. They supervise and oversee staff in duties pertaining to patient billing, communications with health insurance, collections, cash posting, account management, and contract analysis.
Duties include working billing queues as part of a team. This role is based in Brisbane, California, and expected to be on-site at least 3 days per week.
Responsibilities:
- Team Management:
- Provide strategic input & leadership guidance to the RCM team, ensuring a high-performance culture and fostering professional growth.
- Oversee the day-to-day operations of the RCM function, including workload management, task delegation, and performance monitoring.
- Set clear objectives, performance goals, and support development for team members.
- Conduct monthly and routine 1:1s with staff; Mid-Year and Yearly reviews
- Revenue Cycle Optimization:
- Evaluate and improve revenue cycle processes to ensure billing accuracy, reduce denials, and optimize reimbursement.
- Monitor key performance indicators (KPIs) and implement strategies to improve performance.
- Leverage revenue cycle management systems and technologies to enhance efficiency and productivity.
- Compliance and Risk Management:
- Ensure compliance with applicable regulations, billing guidelines, and industry standards.
- Conduct regular audits and reviews to identify compliance risks and implement corrective actions as needed.
- Stay up to date with industry trends, regulatory changes, and reimbursement methodologies, and implement necessary adjustments to maintain compliance.
- Act as a liaison between the RCM team and other departments, fostering effective communication and strong relationships.
- Other duties as assigned
Qualifications:
- Bachelors degree preferred or related years of experience.
- Minimum of 10 years of experience in revenue cycle management systems & technologies, with at least 3 years in a people manager role.
- Extensive knowledge of healthcare billing, coding, and reimbursement practices, including government and commercial payers, specifically within the diagnostics industry.
- Technical depth in at least two of the following areas:
- Telcor System Knowledge: Demonstrated expertise in utilizing Telcor billing system or similar revenue cycle management software. Prior implementation and training experience a plus.
- Prior Authorization: In-depth understanding of the prior authorization process and experience in optimizing workflows and minimizing delays.
- Appeals: Proven track record in managing appeals processes with a comprehensive knowledge of appeal strategies and regulations.
- Analytics & Internal Initiatives: Proficiency in leveraging data analytics tools and methodologies to identify revenue cycle trends, patterns, and opportunities for improvement.
- Proven track record of successfully managing and developing teams, driving performance & internal initiatives, and achieving results.
- Excellent communication and interpersonal skills, with the ability to effectively collaborate cross-functionally with teams and senior leadership.
- Ability to work in a fast-paced environment, navigating ambiguity while balancing multiple priorities.
- Experience with Telcor and SalesForce systems preferred.
#LI-Onsite, LI-Hybrid
