Senior Manager, RCM

Fulgent Genetics; Coppell (TX); Vor Ort; USD 120.000 - 180.000; Vollzeit

Zusammenfassung

Inform Diagnostics, a Fulgent Genetics Company, is seeking a Senior Manager, Revenue Cycle Management to lead coding, data entry, billing, accounts receivable, and reimbursement activities for the team. You will ensure timely, accurate, and compliant filing and foster collaboration across departments.

The role requires maintaining current payer information, implementing policy changes, and overseeing vendor relationships and training to improve operational performance and KPI metrics.

Qualifikationen

• Bachelor's degree in business administration, healthcare or related field.
• Ten years billing experience in a healthcare environment and 7 years of progressive leadership experience.
• Knowledge of Revenue Cycle Management functions, including, but not limited to Data Entry, ICD-10 Coding, Accounts Receivable Management, and Remittance Application.
• Knowledge of medical Anatomical Pathology is a plus.
• Proficient in Microsoft Office Suite, specifically Word, Excel, and Outlook, and general working knowledge of Internet for business use.
• Ability to work in a fast-paced, deadline driven environment.
• Drive for Results (Service, Quality, and Continuous Improvement) Ensure procedures and processes are in place that lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement.
• Proficient verbal and written communication skills. Willingness to share and receive information and ideas from all levels of the organization in order to achieve the desired results.
• Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team.
• Customer Service Focus Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations.

Aufgaben

• Build and oversee the full RCM Integrity program, from patient services to claims submission and collections, ensuring compliance with Payor & ASCP requirements.
• Conduct standard RCM risk assessments and audits across inhouse & offshore practices to identify potential areas of vulnerability and implement corrective action plans as needed.
• Advise senior leadership on matters involving billing integrity, regulatory compliance, and financial risk management.
• Develop, document, and implement approved revenue cycle policies, procedures, and workflows that align with federal and state regulations, payer contracts and reporting requirements.
• Acts as administrator for payor portals & EDI connectivity with Third Party Payors.
• Remain current with changes in reimbursement regulations.
• Collaborates with management on operational performance and changes needed in the operation. Notifies and trains staff on significant coding and billing changes.
• Gather and review reimbursement data, analyzes results, prepares report and oversee the resolution of any identified issues.
• Train clinicians, sales, and billing department staff.
• Assist with the selection, training, and performance evaluation of supervisors and staff.
• Plan, direct, and supervise coding, data entry, billing, and collections supervisors and staff to ensure timely, accurate, and complete processing of services while ensuring all quality and production goals are met.
• Resolve employee relations issues and recommends disciplinary action when required.
• Focus on improving all KPI metrics.

Kenntnisse

Leadership experience

Communication skills

Customer service focus

Drive for results

Ausbildung

Bachelor's degree in business administration, healthcare or related field

Tools

Microsoft Office Suite

Jobbeschreibung

About Us

Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.

Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.

Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike.

Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company.

Summary of Position

The Senior Manager, Revenue Cycle Management is responsible for managing performance and policies administration for coding, data entry, billing, accounts receivable (AR), and reimbursement activities for their team. This includes securing, maintaining, and distributing the most current coding and payer information and implementing changes in a manner that supports timely, accurate and compliant filing and reimbursement. This role will also focus on fostering collaboration between RCM vendors, sales, and clinical departments to improve efficiency and patient experience.

Key Job Elements

• Build and oversee the full RCM Integrity program, from patient services to claims submission and collections, ensuring compliance with Payor & ASCP requirements.
• Conduct standard RCM risk assessments and audits across inhouse & offshore practices to identify potential areas of vulnerability and implement corrective action plans as needed.
• Advise senior leadership on matters involving billing integrity, regulatory compliance, and financial risk management.
• Recommend process improvements and implement approved changes to enhance operational performance.
• Serves as the primary liaison for escalated RCM issues, partnering with clinicians, sales, third-party billing vendors and billing staff.
• Develop, document, and implement approved revenue cycle policies, procedures, and workflows that align with federal and state regulations, payer contracts and reporting requirements.
• Acts as administrator for payor portals & EDI connectivity with Third Party Payors.
• Remain current with changes in reimbursement regulations.
• Collaborates with management on operational performance and changes needed in the operation. Notifies and trains staff on significant coding and billing changes.
• Gather and review reimbursement data, analyzes results, prepares report and oversee the resolution of any identified issues.
• Train clinicians, sales, and billing department staff.
• Assist with the selection, training, and performance evaluation of supervisors and staff.
• Plan, direct, and supervise coding, data entry, billing, and collections supervisors and staff to ensure timely, accurate, and complete processing of services while ensuring all quality and production goals are met.
• Resolve employee relations issues and recommends disciplinary action when required.
• Focus on improving all KPI metrics.

Qualifications

Knowledge/Experience

• Bachelor's degree in business administration, healthcare or related field or equivalent experience.
• Ten years billing experience in a healthcare environment and 7 years of progressive leadership experience.
• Knowledge of Revenue Cycle Management functions, including, but limited to Data Entry, ICD-10 Coding, Accounts Receivable Management, and Remittance Application.
• Knowledge of medical Anatomical Pathology is a plus.
• Proficient in Microsoft Office Suite, specifically Word, Excel, and Outlook, and general working knowledge of Internet for business use.
• Ability to work in a fast-paced, deadline driven environment.
• Drive for Results (Service, Quality, and Continuous Improvement) Ensure procedures and processes are in place that lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement.
• Proficient verbal and written communication skills. Willingness to share and receive information and ideas from all levels of the organization in order to achieve the desired results.
• Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team.
• Customer Service Focus Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations.

Supervisor Responsibilities

• Yes

Reports To

• Director of Revenue Cycle Management

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term "qualified individual with a disability" means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.