Revenue Cycle Manager
About The Position
The Revenue Cycle Manager (RCM) is responsible for overseeing and optimizing the full revenue lifecycle for a growing clinical laboratory while working in coordination with an outsourced billing partner. This role serves as the internal owner of payer strategy, denial management, audit preparedness, and revenue integrity. The ideal candidate has strong experience with clinical laboratory billing, payer policies (Medicare, Medicaid, BCBS), and understands the unique compliance and reimbursement challenges associated with molecular, infectious disease, and specialty diagnostic testing.
Requirements
- 5+ years of revenue cycle experience in healthcare
- 2+ years of direct clinical laboratory billing or RCM experience
- Strong knowledge of: CPT / HCPCS coding ICD-10 diagnosis requirements Medicare, Medicaid, and commercial payer policies
- Experience managing or auditing an outsourced billing vendor
- Proven success improving collections and reducing denials
- Strong analytical, organizational, and communication skills
Nice To Haves
- Experience with molecular diagnostics, toxicology, or infectious disease testing
- Familiarity with BCBS medical policies and Medicare MAC guidance
- Experience supporting payer audits or appeals
- Background working with CLIA-certified laboratories
- Compliance or regulatory knowledge (CMS, OIG risk awareness)
Responsibilities
- Revenue Cycle Oversight Serve as the internal owner of the end-to-end revenue cycle, from test order through payment
- Manage and audit outsourced billing vendor performance
- Ensure accurate CPT/HCPCS coding, modifiers, and diagnosis linkage
- Monitor net collection rate (NCR), days in A/R, denial rates, and first-pass yield
- Denials & Appeals Management Identify denial trends by payer, test type, and ordering provider
- Develop and execute appeal strategies for commercial and government payers
- Coordinate clinical documentation to support medical necessity
- Reduce preventable denials through workflow improvements
- Payer Policy & Compliance Interpret and implement payer medical policies (Medicare MACs, BCBS, Medicaid)
- Serve as subject matter expert on lab reimbursement rules and coverage criteria
- Partner with compliance and clinical leadership to mitigate audit risk
- Assist in preparing for payer audits, recoupments, and post-payment reviews
- Vendor & Payer Management Act as primary liaison with outsourced billing company
- Hold regular performance reviews and data reconciliation meetings
- Coordinate payer enrollment, credentialing, and contract updates
- Support payer negotiations and reimbursement issue resolution
- Reporting & Leadership Support Provide executive-level reporting on revenue performance and risks
- Forecast cash flow and identify revenue leakage
- Recommend process improvements to improve clean claim rates
- Support growth initiatives by assessing reimbursement viability of new tests
Benefits
- All full-time members of the Tsela team receive access to a comprehensive benefits package on the first of the month following their date of hire, including medical, dental, vision, life, disability, and other supplemental benefit options.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
