Revenue Cycle Manager

1 month ago

King of Prussia, United States Genomind Inc. Full time
Job DescriptionJob Description

About Genomind

Genomind is a leading provider of Pharmacogenomic (PGx) testing. Our lab test translates patient genetic data into actionable treatment insights, helping providers and patients narrow down medication choices and personalize dosing for better outcomes. With a successful track record of treating over 350,000 patients, we are expanding our team and seeking key members to join our organization.

Job Summary

We are looking for a highly skilled individual to manage our Revenue Cycle Management (RCM) team. This team oversees end-to-end revenue cycle functions, including: patient registration, financial responsibility & patient estimation processing; eligibility verification; prior authorization submission and tracking; claims submission & tracking; denial and appeal management; patient billing and collection; account receivable management; coding and compliance; and overall alignment of reimbursement & financial measures. The manager’s key goals are to maximize reimbursement and establish an RCM “Center of Excellence” within the organization.

Essential Duties and Accountabilities:

  • Manages the day-to-day operations of the Billing department to maximize net revenues and cash flow by overseeing all aspects of the revenue cycle while ensuring adherence to policies and procedures.
  • Reviews the billing work queue regularly to ensure workloads are distributed appropriately, and department metrics are met.
  • Ensures accurate billing of insurance payors and patient responsibilities, both pre- and post-testing.
  • Monitors account receivable activities and initiates appropriate corrective measures as needed.
  • Identifies and implements processes to achieve key revenue cycle metrics, including A/R days, unbilled A/R, denial percentage, cash collection, for in- and out-of-network payors. Communicates performance data and associated action plans to Senior Leadership.
  • Focuses heavily on out-of-network medical policies to understand eligibility, prior authorization requirements, denials, and appeals trends, to maximize revenue and expand payor contact footprint.
  • Analyzes large volumes of data, providing financial analysis, and regularly presents trends, movements, and status to Senior Leadership.
  • Optimizes Genomind’s testing process, codes, and related materials to maximize overall reimbursement.
  • Works with internal and external stakeholders to accurately and effectively communicate Genomind’s billing policy.
  • Resolves complex patient, provider, and escalation issues via various methods (e.g., email, call center, etc.).
  • Develops and implements policies and procedures for designated areas, evaluating new systems, capabilities, and methods to improve processes and maximize efficiencies.
  • Oversees the hiring, training, and supervision of department personnel, conducting annual performance evaluations.
  • Maintains comprehensive knowledge of third-party billing requirements and reimbursement principles. Also maintains comprehensive working knowledge of payor contracts, ensuring payors are billed according to contract provisions.
  • Stays informed about compliance regulations, standards, and directives from governmental/regulatory agencies and third-party payers.
  • Leads ongoing coding audits to ensure full compliance with billing requirements.
  • Observes all confidentiality and HIPAA provisions.
  • 10-15% travel required.

Education:

  • Bachelor’s Degree or equivalent experience required.
  • Certification through the American Medical Billing Association preferred.

Experience:

  • 5-8 years of experience in a leadership role within Revenue Cycle Management in a healthcare environment.
  • 3-5 years of experience in laboratory/molecular diagnostic billing processes, terminology, and best practices (preferred).
  • Proven experience managing a team of 3–6 members.

Competencies Needed:

  • Exceptional organizational skills, ability to multitask, and detail-oriented approach
  • Demonstrated superior critical thinking and analytical abilities
  • Clear articulation of direction that inspires the team to work toward a common goal
  • Effective verbal and written communication skills, along with strong customer service abilities
  • Excellent interpersonal skills for interacting with internal staff, patients, and customers
  • Proficiency in technology, including Excel, leading RCM, and clearinghouse platforms
  • Understanding of HIPAA compliance and confidentiality policies and procedures
  • Waystar and Telcor experience preferred


Job Classification: Exempt

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