Manager, Billing Operations RCM
About The Position
The Manager, Billing Operations, RCM will directly oversee the day-to-day execution of and mid-cycle and back-end revenue cycle workflows. This role is responsible for ensuring the absolute accuracy, compliance, and timeliness of claim processing, cash posting, and both insurance and client (institutional) billing. The ideal candidate is a hands-on leader focused on eliminating manual claim errors, improving first-pass clean claim rates, and maintaining strict adherence to regulatory and internal compliance standards. The role partners cross-functionally with Market Access, Clinical Operations, Compliance, and Finance to ensure seamless claim generation and reimbursement readiness.
Requirements
- 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.
Nice To Haves
- Experience in diagnostic laboratory, genetics, molecular diagnostics, or precision medicine.
- Strong familiarity with payer medical policies and reimbursement methodologies.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
