At Caris, we understand that cancer is an ugly word—a word no one wants to hear, but one that connects us all. That’s why we’re not just transforming cancer care—we’re changing lives.
We introduced precision medicine to the world and built an industry around the idea that every patient deserves answers as unique as their DNA. Backed by cutting-edge molecular science and AI, we ask ourselves every day: “What would I do if this patient were my mom?” That question drives everything we do.
But our mission doesn’t stop with cancer. We're pushing the frontiers of medicine and leading a revolution in healthcare—driven by innovation, compassion, and purpose.
Join us in our mission to improve the human condition across multiple diseases. If you're passionate about meaningful work and want to be part of something bigger than yourself, Caris is where your impact begins.
Position Summary
Caris Life Sciences is seeking an experienced and strategic Director of Billing Operations - Appeals to lead the appeals management function for an assigned payor group. The ideal candidate will possess a deep understanding of molecular pathology billing, medical necessity requirements, and payor-specific policies related to laboratory and genetic testing services.
This role is responsible for overseeing appeals processes associated with denials from Caris-contracted and non-contracted commercial and government payors, identifying root causes of denials, ensuring compliance with payor-specific guidelines, and driving optimal recovery through timely, accurate, and persuasive appeals.
Job Responsibilities
Lead the appeals and reconsideration process for denied Caris claims, including those for CGP (comprehensive genomic profiling) and other proprietary diagnostic services.
Implement a strategic appeal workflow tailored to the unique requirements of Caris’s clinical and scientific offerings.
Monitor appeal success rates, overturn trends, and response times, adjusting strategy as needed to maximize reimbursement and reduce write-offs.
Maintain current, detailed knowledge of Caris payor contracts, lab billing policies, and payor-specific denial patterns (e.g., related to experimental/investigational classifications, lack of medical necessity, or coding disputes).
Collaborate closely with Caris’s Market Access teams to escalate systemic denial trends and assist in contract negotiations when necessary.
Serve as a subject matter expert in appeals for assigned payor group.
Manage a team of appeals specialists, analysts, and support staff with a deep focus on Caris’s unique test offerings and the molecular diagnostics payor landscape.
Provide ongoing training, mentorship, and performance feedback to ensure high-quality, data-driven appeal submissions.
Maintain documentation for audit readiness, including appeal tracking, letter history, and supporting clinical or legal documentation.
Required Qualifications
Bachelor’s degree in Healthcare Administration or equivalent experience.
Minimum of 7 years of healthcare revenue cycle experience, including 3+ years in laboratory, diagnostics, or molecular/genomic services.
5+ years of leadership experience in a healthcare or life sciences setting.
Proven experience with high-volume, complex payor appeals, ideally in a precision medicine or laboratory testing environment.
In-depth knowledge of coding and billing for molecular diagnostics (CPT codes, PLA codes, Tier 1/2 codes, Z-codes, etc.).
Strong understanding of commercial and government payor reimbursement policies related to lab services and medical necessity.
Exceptional analytical, writing, and communication skills.
Preferred Qualifications
Prior experience at a molecular diagnostics or precision medicine company.
Experience with Epic, Xifin, or similar billing/revenue cycle platforms.
Successful track record of managing appeals for tests deemed experimental or not medically necessary by payors.
Experience in healthcare call center management is a plus.
Physical Demands
Must possess ability to sit and/or stand for long periods of time.
Must possess ability to perform repetitive motion.
Ability to lift up to 15 pounds.
The majority of work is performed in a desk/cubicle environment.
Training
All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.
Other
This position requires periodic travel and some evenings, weekends and/or holidays.
Conditions of Employment: Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions ) and reference verification.
This job description reflects management’s assignment of essential functions. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.