Manager, Billing Operations RCM

Key Responsibilities

• Oversee end-to-end processing of diagnostic claims to ensure completeness, accuracy, and payer readiness.
• Validate appropriate code stacking, modifiers, documentation, and payer-specific requirements prior to submission.
• Drive improvements in clean claim rate and reduce avoidable rework.
• Lead dual-path billing infrastructure supporting both insurance claims and institutional/client invoicing.
• Oversee client billing processes including fee schedules and invoicing cycles.
• Supervise cash application processes across ERA, EFT, lockbox, check, and patient payments.
• Ensure timely and accurate posting aligned to defined turnaround times (TAT).
• Monitor reconciliation processes to reduce unapplied cash and posting discrepancies.
• Serve as primary escalation point for clearinghouse edits, system errors, and claim rejects.
• Implement controls to prevent recurring errors and improve submission quality.
• Ensure adherence to HIPAA, CMS/OIG guidance, and state/federal laboratory billing regulations.
• Establish routine audit processes to validate billing accuracy and compliance.
• Partner with Compliance and Legal on risk mitigation and audit readiness.
• Leverage RCM platforms and rule engines to reduce manual touchpoints and increase automation.
• Drive continuous improvement initiatives to accelerate time-to-bill and increase operational efficiency.
• Standardize workflows, SOPs, and training across billing teams.
• Develop and monitor KPIs including Clean Claim Rate (CCR), Days Sales Outstanding (DSO), submission timeliness, and posting accuracy.
• Produce operational dashboards and insights to drive accountability and improvement.
• Lead productivity management and performance reviews for billing and cash posting teams.

Qualifications

• 6+ years of progressive healthcare RCM experience, including billing and cash posting operations.
• 2–3+ years of leadership experience managing billing or revenue cycle teams.
• Strong understanding of insurance billing, client invoicing, and complex coding workflows.
• Experience with RCM systems (Xifin, Telcor, Quadax, or similar) and clearinghouse/EDI transactions (837, 835, 270/271).
• Demonstrated ability to improve claim quality, reduce errors, and drive 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 familiarity with payer medical policies and reimbursement methodologies.