Director, Billing Operations

Scipher Medicine develops innovative diagnostic tests to determine drug response and targeted therapies using its proprietary personalized medicine platform based on molecular technology. Our platform allows us to interpret genomic data to gain unique insights into disease biology so patients with even the most complex diseases can achieve optimal health outcomes.

With only about 1 out of 3 patients adequately responding to anti-tumor necrosis (anti-TNF) therapies, the world’s largest selling drug class, we developed our flagship test, PrismRA™, to predict response to these drugs, thereby ensuring patients receive the most effective therapies from day one. Scipher is transforming the traditional diagnostics business model by working closely with payers to change the way medications will be prescribed, saving both insurers and patients billions wasted in ineffective prescription costs. This is a unique opportunity to join a promising venture at an early stage to tackle some of the biggest problems in healthcare.

We are proud of our passionate, high-performance, mission-driven culture – one based on a set of values that are the cornerstone of who we are and how we hold ourselves accountable. Founded in 2015, we are based in Waltham, MA and currently expanding across all functions within the organization. We are backed by Khosla Ventures, Northpond Ventures, Alumni Ventures and Tachyon Ventures, and are well capitalized to execute our vision of launching a personalized medicine platform that transforms patients’ lives. Check us out at www.sciphermedicine.com and follow us on LinkedIn.

The Role: The Director, Billing Operations is responsible for leading and planning the billing operations for our growing Market Access team. They are responsible for designing, implementing and enforcing policies and procedures, as well as streamlining effective billing processes across multiple markets. They will handle all components of claims processing, including coordination of disputed, rejected and delayed claims and to review returned, disputed or rejected claims from Medicare and other third-party payers, and problem solving. This person is also responsible for communicating and training the billers regarding coding processes to prevent denials. The role is highly visible and requires a strong leader with the ability to prioritize and plan.

Where: Waltham, MA

What will I do?
– Work closely with the external billing vendor to ensure billing accuracy, compliance and revenue optimization
– Work closely with leadership to develop, implement and maintain SOPs
– Perform audits of the systems and procedures to ensure the accuracy of all charges and CPT codes
– Review patients’ billing statements to ensure accuracy of information
– Assist in evaluating patients’ financial status and devise payment plans
– Follow up on delinquent accounts and ensure payments where possible
– Submit claims and resubmit denied claims
– Ensure processing of payments from insurance companies and client billing accounts
– Prepare daily deposit activities
– Maintain payment status and billing records
– Prepare reports and perform analysis of billing documents
– Document transactions appropriately
– Track and resolve billing discrepancies
– Activate and deactivate patients’ accounts upon request
– Work with healthcare providers, patients and insurance companies to ensure timely payment of bills
– Verify patients’ insurance coverage
– Perform appeals on denied claims
– Manage accounts receivable reports
– Answer questions and resolve problems regarding medical billing activities
– Verify the accuracy of posted billing information

Minimum Education and Qualifications:
– Work closely with the external billing vendor to ensure billing accuracy, compliance and revenue optimization
– Work closely with leadership to develop, implement and maintain SOPs
– Perform audits of the systems and procedures to ensure the accuracy of all charges and CPT codes
– Review patients’ billing statements to ensure accuracy of information
– Assist in evaluating patients’ financial status and devise payment plans
– Follow up on delinquent accounts and ensure payments where possible
– Submit claims and resubmit denied claims
– Ensure processing of payments from insurance companies and client billing accounts
– Prepare daily deposit activities
– Maintain payment status and billing records
– Prepare reports and perform analysis of billing documents
– Document transactions appropriately
– Track and resolve billing discrepancies
– Activate and deactivate patients’ accounts upon request
– Work with healthcare providers, patients and insurance companies to ensure timely payment of bills
– Verify patients’ insurance coverage
– Perform appeals on denied claims
– Manage accounts receivable reports
– Answer questions and resolve problems regarding medical billing activities
– Verify the accuracy of posted billing information

To all recruitment agencies: Scipher Medicine does not accept agency resumes. Please do not forward resumes to our jobs alias, or Scipher Medicine employees. Scipher Medicine is not responsible for any fees related to unsolicited resumes.

Scipher Medicine is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.  Scipher will make reasonable accommodations for qualified individuals with known disabilities, in accordance with applicable law.  

IF INTERESTED IN EXPLORING THIS OPPORTUNITY PLEASE EMAIL YOUR RESUME TO CAREERS@SCIPHERMEDICINE.COM