Medical Billing Operations Specialist II # 4218

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.

GRAIL is seeking a Billing Operations Specialist II who will be responsible for insurance claims follow-up, denial management, and appeals support. This position will monitor the claim submission process and track claims through full adjudication, ensuring timely and accurate reimbursement.

Responsibilities:

• Perform outreach to payors regarding outstanding insurance claims to ensure timely payment.
• Verify patient insurance coverage and benefits.
• Collaborate with the Prior Authorization team to obtain prior authorization when required by payors.
• Review denied claims and work with payors to reprocess or appeal them as necessary.
• Assist the billing vendor with the creation of claims appeals and monitor their resolution.
• Communicate with payors, healthcare providers (HCPs), and patients to gather essential information for accurate billing.
• Maintain accurate and up-to-date records of claim statuses, appeals, and authorizations in the billing system.
• Collaborate with the internal billing team and external billing vendor to ensure accurate and timely claim submission.
• Document all interactions and calls within the billing system and Salesforce (if applicable).
• Support the Billing Operations team by providing outreach to patients and HCPs when needed, to resolve front-end errors and/or back-end claim denials.
• Work independently and as part of a team.
• Perform duties in a high-volume work environment.
• Comply with PCI, CLIA, CAP, HIPAA, and other applicable state, federal, and regulatory guidelines.
• Adhere to standard operating procedures (SOPs) related to medical billing, customer service, and accessioning issue resolution.

Preferred Qualifications:

• A minimum of 2+ years of relevant experience with a bachelor’s degree or equivalent experience in medical billing.
• At least 2 years of experience in billing accounts receivable (AR), claims denial management, and appeals.
• Knowledge of medical terminology, insurance billing procedures, and coding systems (ICD-10, CPT).
• Strong communication and customer service skills.
• Proficiency in using electronic health records (EHR) and billing software.
• Ability to work independently and prioritize tasks effectively.
• High attention to detail and strong organizational skills.
• Technical proficiency with tools such as Google Docs and Google Sheets.
• Medical Billing certification from a reputable institution (e.g., American Academy of Professional Coders / AAPC).
• Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) certification is a plus.

Expected full time annual base pay scale for this position is $70K-$82K. 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.