Billing & Medical Ops Manager — Revenue Cycle Leader

Reliance Rx Specialty Pharmacy; Buffalo (NY); Hybrid; USD 77,000 - 95,000; Full time

Benefits offered by this job

Scorecard incentive

Full range of benefits

Generous paid time off

Job summary

Reliance Rx Specialty Pharmacy in Williamsville, NY is seeking a Manager-Billing and Medical Operations to supervise pharmacy and medical claims processing, lead the billing and medical operations teams, and drive revenue cycle improvements. You will monitor daily metrics, perform audits, and ensure timely, accurate submissions across NCPDP and medical claims.

The role requires a bachelor’s degree and 5+ years in third-party billing with two years in specialty settings, plus leadership

Qualifications

• Bachelor's degree required; four years' experience in lieu.
• Five years third party claims billing, patient collections, or high-volume pharmacy experience required, including two years in specialty.
• Two years progressive leadership/management responsibility required.
• Specialty pharmacy and copay assistance billing strongly preferred.
• Medical billing and 837 claim transaction experience strongly preferred.
• Strong leadership, coaching and mentoring skills with the ability to address issues objectively.
• Excellent written and verbal communication and problem-solving skills.
• Excellent organizational, process and time management skills.
• Demonstrated alignment with Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, Supportive.

Responsibilities

• Oversee all NCPDP claims processing, medical claims submission via 837 and CMS1500, copay assistance billing, and paper claims submission when necessary.
• Subject matter expert on pharmacy benefits vs medical benefits and NCPDP vs medical claims; train team on differences.
• Serve as the subject matter expert for all billing issues; develop best practices; address escalated issues.
• Knowledgeable on resolving rejections and reading paid claim responses to identify discrepancies.
• Maintain knowledge of regulatory requirements for billing (Medicare/Medicaid); ensure payer compliance and SLAs.
• Directly coach the Billing Specialist team; monitor productivity and performance metrics.
• Oversee patient and insurance accounts receivable; monitor workflow from submission to denial resolution.
• Lead 837 file submission management and work with payors for implementation/testing.
• Collaborate with Finance, Infusion, and Account Management to resolve discrepancies and improve revenue cycle.
• Work with infusion, clinical account pharmacists, and regional sales executives on strategic service offerings.
• Collaborate to achieve departmental goals and quality metrics.

Skills

Leadership

Communication

Problem solving

Regulatory knowledge

Revenue cycle

Mentoring

Time management

Process improvement

Training

Education

Bachelor's degree

Job description

Reliance Rx Specialty Pharmacy in Williamsville, NY is seeking a Manager-Billing and Medical Operations to supervise pharmacy and medical claims processing, lead the billing and medical operations teams, and drive revenue cycle improvements. You will monitor daily metrics, perform audits, and ensure timely, accurate submissions across NCPDP and medical claims.

The role requires a bachelor’s degree and 5+ years in third-party billing with two years in specialty settings, plus leadership