Billing & Medical Operations Manager - Hybrid

Independent Health; Buffalo (NY); Hybrid; USD 77,000 - 95,000; Full time

Benefits offered by this job

Hybrid work arrangement

Onsite Williamsville location

Job summary

Reliance Rx Specialty Pharmacy Management, LLC seeks a Manager-Billing and Medical Operations in Buffalo, NY. The role supervises pharmacy and medical claims processing, including NCPDP and 837/CMS1500 activities, and leads billing operations teams to ensure timely submissions and accurate reimbursements.

The position requires strong leadership, regulatory knowledge, and a proven track record in high-volume billing.

Qualifications

• Bachelor’s degree required; additional four years may substitute.
• Five years of experience with third party claims billing, patient collections, or high-volume pharmacy required, including two years in specialty pharmacy.
• Two years of progressive leadership/management responsibility required.
• Specialty pharmacy and copay assistance billing strongly preferred.
• Medical billing and 837 claim transaction experience strongly preferred.

Responsibilities

• Oversee NCPDP claims processing, medical claims submission via 837 and CMS1500, copay assistance billing, and paper claims when needed.
• Serve as subject matter expert on billing differences between pharmacy benefits and medical benefits.
• Lead escalation reviews, root cause analyses, and disciplinary actions as needed.
• Maintain knowledge of Medicare/Medicaid billing regulations and ensure payer compliance.
• Monitor AR, denial management, and aging balances; drive revenue cycle improvements.
• Collaborate with Finance, Infusion, and Account Management to resolve discrepancies.

Skills

Billing leadership

NCPDP claims

837/CMS1500 processing

Regulatory compliance

Education

Bachelor’s degree

Tools

NCPDP claims systems

837 file development

Job description

Reliance Rx Specialty Pharmacy Management, LLC seeks a Manager-Billing and Medical Operations in Buffalo, NY. The role supervises pharmacy and medical claims processing, including NCPDP and 837/CMS1500 activities, and leads billing operations teams to ensure timely submissions and accurate reimbursements.

The position requires strong leadership, regulatory knowledge, and a proven track record in high-volume billing.