Manager, Billing Operations, RCM

🕒 Maio 28

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Baylor Genetics

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1978

🧬 Biotecnologia

🔬 Ciência

Biotechnology • Science

A Baylor Genetics é um laboratório de genômica clínica e diagnóstico de precisão afiliado ao Baylor College of Medicine, que oferece serviços abrangentes de teste genético e interpretação. A empresa oferece sequenciamento do genoma completo e do exoma completo, análise cromossômica por microarray, testes mitocondriais, farmacogenômica e ensaios especializados, juntamente com aconselhamento genético, suporte para prestadores de serviços e recursos de seguro/pagamento. A Baylor Genetics apoia prestadores de saúde, pesquisadores e famílias com interpretação aprimorada por IA, integração de dados multimodais e serviços clínicos e laboratoriais de ponta a ponta.

Descrição

• 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.

🎯 Requisitos

• 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.

🏖️ Benefícios

• 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.