Revenue Cycle Director jobs in San Jose, CA

Do you want to join one of the fastest-growing molecular diagnostics startups and develop products that can affect the lives of millions?

BillionToOne, ranked at the top 5% of Y Combinator companies with $300M in funding from prominent VC firms, has developed a DNA molecular counter that increases cfDNA diagnostic resolution by over 1,000 fold. BillionToOne's first product, UNITY™ is the first and only non-invasive prenatal test that can directly screen an unborn baby and assess its risk for common and severe recessive gene disorders and chromosomal abnormalities, as well as fetal sex and fetal antigens, from a single tube of blood from the pregnant mother without paternal testing.

In 2023, BillionToOne launched two liquid biopsy products that will markedly improve oncology treatment and care. With Northstar Select™, clinicians will be able to select cancer therapies that will be most effective to each patient based on their individual genetic makeup. Northstar Response™ will enable clinicians to monitor a patient’s early response to these cancer therapies, by measuring minute changes in their ctDNA, which can reduce ineffective treatments and unwanted toxicity, lower costs, and substantially improve clinical outcomes.

We are looking for a Revenue Cycle/Medical Collections Associate to be responsible for focusing on collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers. This is a remote position and will report to the Manager of Reimbursement Operations. The ideal candidate must be able to:

(1) Optimize payment reimbursements by reviewing accounts for billing accuracy and health plan coverage.

(2) Be persuasive and persistent when following up on claims status, and

(3) process an appeal, resubmit/rebill, or forward claims for adjudication as necessary. 

Responsibilities:

• Verify claim was submitted to correct insurance.
• Review/update patient demographics and information for accuracy.
• Process and validate payor requests and claims via correspondence, remittance advice and EOBs (i.e., identify payment discrepancies, inappropriate requests)
• Investigate all denied services to determine reason and appeal, if appropriate.  Identify and report root causes associated with denials to reduce/resolve issues.
• Process assigned appeals including submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes)
• Maximize utilization of Billing system, tools and resources to support cash collection activities
• Review various reports including aging outstanding and denial reports.
• Comply with Federal and State legislation on all billing related matters.
• Comply with all Safety, Emergency, Hazard, OSHA, HIPAA, Quality Assurance and Administrative Plans, Policies, Guidelines, Protocol, and Standards.
• Support and maintain department cash and DSO goals.

Qualifications:

• Minimum of 4 years specializing in Medical Collections at a diagnostics company, laboratory or other healthcare provider, doing collections from commercial payers. 
• Hands-on experience handling the entire appeals process
• Must possess detailed knowledge of all medical benefit levels and have a thorough understanding of Federal, State, & PPO, HMO, and Indemnity Plans structures. 
• Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.
• High School Diploma or a Bachelor’s degree from a four-year college or university
• Strong problem solving skills with ability to streamline and improve processes, use good judgment, attention to detail and follow-through are a must.
• Excellent customer service skills; excellent verbal and written communication skills
• Excellent troubleshooting and time management skills, attention to detail, utilizes time in constructive manner
• Ability to easily adapt to increased business demands 
• Ability to effectively work with and resolve complex accounts & billing issues
• Self-starter, ability to work independently and be self-motivated to overachieve goals.   
• Ability to effectively prioritize and multi-task
• Ability to work in fast paced environment, perform under pressure, meet tight timelines  
• Establish and maintain cohesive and good working relationships

Benefits And Perks:

• Working with a team of ‘rockstars’ who bring out the best in everyone
• Open, transparent culture that includes weekly Town Hall meetings
• The ability to indirectly or directly change the lives of hundreds of thousand patients
• Multiple medical benefit options; employee premiums paid 100% of select plans, dependents covered at 80%
• Extremely generous Family Bonding Leave for new parents (16 weeks, paid at 100%)
• Retirement savings program including a 4% Company match
• Free daily on-site lunches provided from top eateries
• Latest and greatest hardware (laptop, lab equipment, facilities)
• A variety of perks on campus (state of the art gym, restaurant)
• Free on-site EV charging (compatible with all EVs, including Tesla)

At BillionToOne, we are proud to offer a combination of (1) competitive base pay, (2) the opportunity for professional growth, and (3) industry leading company benefits (free healthcare options, 401k match, very generous fully paid parental leave etc.).

"}" data-sheets-userformat="{"2":769,"3":{"1":0},"11":4,"12":0}">For this position, the base pay rate is: $25-$27 per hour.

BillionToOne is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.