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.

GRAIL is seeking a Senior Director, Billing Operations & Reimbursement who is responsible for leading a team, and developing scalable end-to-end billing processes to ensure accurate and timely benefit investigations, prior authorizations, insurance claims submissions, appeals, patient and client billing. The ability to build professional relationships and able to carry out accountability and drive change. A strong candidate should have exceptional knowledge with health plan behaviors in reimbursement and denials. A top talent would have experience in billing operations at molecular diagnostic or genetic testing companies is a plus.

You will:

• Work closely with internal stakeholders and business partners to develop scalable billing systems and processes, then implement improvements that support revenue cycle goals
• Develop and implement best practice methodology for billing system and process optimization
• Working in collaboration with senior leaders, sales, and clinical staff to effect change in our systems and processes
• Collaborate with Finance to evaluate and recommend optimal revenue cycle organizational structure and standard metrics to monitor revenue recognition
• Work closely with Finance, Commercial Operations and our 3rd party billing vendor to monitor trends in denials, appeals and revenue
• Works proactively and closely with finance and the compliance team to ensure compliance with federal, state and local legal requirements by researching existing and new legislation, consulting with outside advisors, and filing financial reports. Advises management of actions and potential risks
• Ensures consistent and actionable communication with key customers
• Working with Finance, ensures Provide reporting and feedback to various departments for correct coding and billing of patient accounts
• Experience in a complex shared service environment with multiple reporting relationships
• Experience managing complex/large scale/ transformational projects, including demonstrated success in coordinating major projects
• Knowledge of all payer types, related healthcare terminology and institutional billing

Your background should include:

• BA/BS in Accounting or Finance preferred, or equivalent work experience
• Knowledge of CPT coding, ICD-9 and ICD-10 with previous experience working in laboratory billing, including medicare
• 15+ years experience with a minimum 7 years billing operations experience in healthcare
• Leadership and start up experience in medical billing and revenue cycle is required
• Understanding the claim submission process and ability to verify the transmission of electronic claims
• Knowledge of standard healthcare remark and reason codes driving denials
• Knowledge of Medicare billing policies including modifiers, NCD and LCD
• Experience working with sensitive patient information
• Ability to interpret various explanations of benefits ("EOB") from the insurance companies.
• Understanding of medical and insurance terminology
• Ability to influence via communication and interpersonal skills
• Ability to handle a wide work variety in a fast-paced environment
• You are meticulous, organized, self-starting, and have an ability to prioritize workload
• Compliance, Law & Ethics (HIPAA) knowledge is preferred
• Experience with third party laboratory billing software is highly desired

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.