Manager, Billing Operations, RCM

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

📋 Description

• Manage the comprehensive processing of diagnostic claims to guarantee completeness, accuracy, and readiness for payer submission.

• Verify correct code stacking, modifiers, documentation, and adherence to payer-specific requirements before submission.

• Promote enhancements in clean claim rates and minimize unnecessary rework.

• Lead the dual-path billing framework that accommodates both insurance claims and institutional/client invoicing.

• Oversee client billing operations, including fee schedules and invoicing cycles.

• Supervise cash application processes encompassing ERA, EFT, lockbox, check, and patient payments.

• Ensure timely and precise posting in accordance with established turnaround times (TAT).

• Monitor reconciliation processes to decrease unapplied cash and resolve posting discrepancies.

• Act as the main escalation point for clearinghouse edits, system errors, and claim rejections.

• Establish controls to prevent recurring errors and enhance submission quality.

• Ensure compliance with HIPAA, CMS/OIG guidelines, and state/federal laboratory billing regulations.

• Develop routine audit processes to verify billing accuracy and compliance.

• Collaborate with Compliance and Legal teams for risk mitigation and audit preparedness.

• Utilize RCM platforms and rule engines to minimize manual interventions and boost automation.

• Propel continuous improvement initiatives to expedite time-to-bill and enhance operational efficiency.

• Standardize workflows, standard operating procedures (SOPs), and training across billing teams.

• Create and track key performance indicators (KPIs) such as Clean Claim Rate (CCR), Days Sales Outstanding (DSO), submission timeliness, and posting accuracy.

• Generate operational dashboards and insights to foster accountability and improvement.

• Guide productivity management and performance evaluations for billing and cash posting teams.

⛳️ Requirements

• A minimum of 6 years of progressive experience in healthcare revenue cycle management (RCM), including billing and cash posting operations.

• At least 2 to 3 years of leadership experience in managing billing or revenue cycle teams.

• In-depth understanding of insurance billing, client invoicing, and complex coding workflows.

• Proficient in RCM systems (such as Xifin, Telcor, Quadax, or similar) and clearinghouse/EDI transactions (837, 835, 270/271).

• Proven track record of enhancing claim quality, reducing errors, and driving operational KPIs.

• Bachelor’s degree in Nursing, Health Sciences, Healthcare Administration, Public Health, or a related field, or an equivalent combination of education and experience.

• Preferred: Experience in diagnostic laboratory, genetics, molecular diagnostics, or precision medicine.

• Strong knowledge of payer medical policies and reimbursement methodologies.

🏝️ Benefits

• EEO STATEMENT Baylor Genetics is proud to be an equal opportunity employer committed to fostering an inclusive and diverse workplace. We welcome and encourage applicants from all backgrounds to apply. We do not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, pregnancy, childbirth, or any other status protected by applicable federal, state, or local law.

• If you need an accommodation during the application process, please contact our Human Resources team.

• Note to Recruiters: We value building direct relationships with our candidates and prefer to manage our hiring process internally. While we occasionally partner with select recruitment agencies for specialized roles, we do not accept unsolicited resumes from recruiters or agencies without a written agreement executed by the authorized signatory for Baylor Genetics ("Agreement"). Any resumes submitted to Baylor Genetics in the absence of an Agreement executed by Baylor Genetics' authorized signatory will be considered the property of Baylor Genetics, and Baylor Genetics will not be obligated to pay any associated recruitment fees.