Associate Director, Medical Prior Authorization and Billing Ops # 4212

Our mission is to detect cancer early, when it can be cured. We are working to change the trajectory of cancer mortality and bring stakeholders together to adopt innovative, safe, and effective technologies that can transform cancer care.

We are a healthcare company, pioneering new technologies to advance early cancer detection. We have built a multi-disciplinary organization of scientists, engineers, and physicians and we are using the power of next-generation sequencing (NGS), population-scale clinical studies, and state-of-the-art computer science and data science to overcome one of medicine’s greatest challenges.

GRAIL is headquartered in Menlo Park, California, 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 grail.com.

The Associate Director will proficiently lead the Prior Authorization, Billing Data Entry, and Billing Operations teams, ensuring a comprehensive understanding of GRAIL’s billing information system and all facets of revenue cycle management. They will oversee daily activities of the billing staff, managing all aspects of prior authorization billing, pre-certification, and eligibility functions. The Associate Director will achieve strategic goals by leveraging their leadership team, guiding individuals who organize and plan daily workflow activities for billing staff members. Additionally, they will contribute to strategic planning and serve in an advisory capacity as part of the leadership team.

This is a hybrid role and requires you to be onsite 2 days a week in Durham, NC.

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.

Expected full time annual base pay scale for this position is $121K-$151K. Actual base pay will consider skills, experience and location.

Based on the role, colleagues may be eligible to participate in an annual bonus plan tied to company and individual performance, or an incentive plan. We also offer a long-term incentive plan to align company and colleague success over time.

In addition, GRAIL offers a progressive benefit package, including flexible time-off, a 401k with a company match, and alongside our medical, dental, vision plans, carefully selected mindfulness offerings.

GRAIL is an Equal Employment Employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability or any other legally protected status. We will reasonably accommodate all individuals with disabilities so that they can participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation. GRAIL maintains a drug-free workplace.