Director, Revenue Cycle Operations

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Act as the primary revenue cycle representative for the Tempus AI Diagnostics business unit.

• Convert business objectives into actionable operational plans and performance benchmarks.

• Provide guidance to business leaders regarding revenue cycle effects of new tests, payer requirements, client agreements, pricing strategies, coverage policies, and operational changes.

• Lead initiatives across functions for governance, performance oversight, risk mitigation, prioritization, and resolution of issues.

• Manage daily revenue cycle operations for the diagnostic laboratory, encompassing intake, eligibility, authorization, charge capture, coding, claims processing, payment posting, denials, appeals, patient billing, collections, and reporting.

• Develop and enhance revenue cycle key performance indicators (KPIs), such as clean claim rate, denial rate, accounts receivable days, cash collections, net collection rate, authorization turnaround time, and patient balance outcomes.

• Identify areas of operational leakage, denials, delayed reimbursements, and billing inaccuracies; spearhead corrective measures.

• Ensure the establishment of operational controls, proper documentation, escalation procedures, and audit preparedness.

• Collaborate with internal teams and vendors to enhance workflows and service-level performance.

• Oversee and optimize Quadax workflows, work queues, claims and remittance processes, reporting, and exception management.

• Manage Quadax resources and data related to claims management, denial avoidance, payment reconciliation, and reporting.

• Define requirements, prioritize improvements, validate modifications, and manage the impacts of implementation.

• Set standards for Quadax data integrity, workflow setup, user engagement, reporting accuracy, and issue resolution.

• Utilize expertise in diagnostic laboratory billing and reimbursement, including CPT/HCPCS, ICD-10, medical necessity, payer edits, coverage criteria, claim regulations, and appeals.

• Track reimbursement patterns and changes in regulations or payer policies.

• Facilitate operational launches of new diagnostic services through readiness in revenue cycle processes, systems, controls, and training initiatives.

• Mentor, coach, and develop revenue cycle personnel and/or vendor partners.

• Create service-level agreements, conduct performance evaluations, and establish escalation procedures for external partners.

• Drive complex operational change initiatives through implementation, adoption, measurement, and refinement.

• Generate executive-ready reports and convey performance metrics, risks, decisions, and recommendations to senior stakeholders.

⛳️ Requirements

• Bachelor’s degree in business, healthcare administration, finance, or a related field; equivalent experience may be taken into account.

• Over 10 years of advancing revenue cycle operations experience, including significant experience in diagnostic laboratory, molecular diagnostics, genetic testing, pathology, or a closely related laboratory environment.

• More than 5 years of experience in leading teams, programs, or major operational roles at a manager, senior manager, director, or equivalent level.

• Direct, hands-on experience with Quadax, including workflow management, claims and remittance processes, reporting, issue resolution, and system optimization.

• Comprehensive understanding of the complete diagnostic laboratory revenue cycle.

• Proven expertise in laboratory reimbursement requirements, payer policies, medical necessity determinations, coding, billing edits, and denial prevention strategies.

• Demonstrated ability to leverage operational and financial data to pinpoint performance deficiencies, prioritize actions, and achieve measurable improvements.

• Experience in leading cross-functional initiatives involving business, operational, technical, financial, and compliance stakeholders.

• Excellent executive communication, relationship-building, problem-solving, and change management abilities.

• Preferred: Master’s degree in healthcare administration, business administration, finance, or a related field.

• Preferred: Background in supporting high-complexity molecular, genomic, oncology, or AI-driven diagnostic testing.

• Preferred: Experience in managing third-party revenue cycle vendors and establishing service-level agreements and performance metrics.

• Preferred: Knowledge of laboratory information systems, electronic health record integrations, clearinghouses, and revenue cycle analytics tools.

• Preferred: Certification in Lean, Six Sigma, project management, or other process improvement methodologies.

🏝️ Benefits

• Incentive compensation may be available.

• Restricted stock units may be available.

• Medical and additional benefits may be provided based on the position.

• Remote work options available within Illinois.