Associate Director, Medical Prior Authorization and Billing Ops #4212

Responsibilities

• Build an in-house prior authorization team and design processes to ensure maximized revenue collection.
• Manage all front-end billing operations, including hiring, training, development, coaching, corrective actions, and ongoing monitoring of staff activities.
• Direct Billing Operations management and staff to ensure accurate claim/invoice submissions and timely collections in accordance with third-party contract terms.
• Maximize cash collections through diligent and timely monitoring of all open accounts receivable balances.
• Support the Billing Operations Manager in resolving reimbursement issues with third-party payers and provide guidance to senior leadership regarding contracting challenges.
• Establish and maintain billing data, including rate schedules and payer information.
• Analyze reimbursement from all sources, monitor payer reimbursement exceptions, and manage pending claims and denials.
• Maintain and enhance billing policies and procedures, ensuring staff adherence.
• Review detailed analyses and reports of billing and accounts receivable activity, including performance metrics and days outstanding, to ensure KPIs are met.
• Ensure consistent quality of billing services by assigning tasks based on skill levels and monitoring departmental productivity.
• Ensure the third-party billing system meets KPIs and follows established procedures.
• Collaborate with the Revenue team to analyze billing activity for monthly financial reporting.
• Identify and implement opportunities for automation and process improvement.
• Assist with other related duties and special projects as needed.
• Provide mentoring, coaching, and performance reviews for direct reports.
• Develop and monitor operating procedures, implementing workflow changes to improve productivity as necessary.
• Hold billing operations management accountable for performance and production standards.
• Provide direction and development opportunities through routine coaching and development plans.
• Assess performance and provide timely, constructive feedback to staff.
• Prepare and conduct annual performance evaluations and recommend merit increases and bonus percentages.
• Ensure compliance with PCI, CLIA, CAP, HIPAA, and other applicable regulatory guidelines.

Preferred Qualifications:

• Bachelor’s degree in a related field or equivalent experience required.
• Minimum of 8 years’ experience managing a high-volume, fast-growing billing office in a laboratory setting (staff of 10+ preferred).
• Extensive experience in Prior Authorization billing operations.
• Strong knowledge of reimbursement, billing, coding, and compliance regulations.
• Demonstrated leadership and startup experience in medical billing and revenue cycle management.
• Ability to manage a wide variety of work in a fast-paced environment through effective planning, delegation, and coaching.
• Strong communication and collaboration skills across cross-functional teams and senior leadership.
• Effective planning, organizational, and delegation abilities.
• Ability to respond to change quickly and develop creative solutions to evolving business needs.
• Skilled in researching, interpreting, and concisely presenting data.
• Leads by example and demonstrates a passion for excellence.
• Maintains high standards of professionalism, discipline, and decision-making.
• Inspires teams to surpass performance goals and successfully manage a growing workforce.
• Excellent verbal and written communication skills.
• Open to sharing and receiving ideas across all levels of the organization to achieve results.
• Committed to team and organizational success, with a strong willingness to support and engage colleagues.