Manager, Billing Operations RCM

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.

KEY RESPONSIBILITIES

Claim Processing & Accuracy

• 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.

Billing Operations (Insurance & Client)

• Lead dual-path billing infrastructure supporting both insurance claims and institutional/client invoicing.
• Oversee client billing processes including fee schedules and invoicing cycles.

Cash Posting & Reconciliation

• 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.

Error Resolution & Edit Management

• Serve as primary escalation point for clearinghouse edits, system errors, and claim rejects.
• Implement controls to prevent recurring errors and improve submission quality.

Compliance & Quality Assurance

• 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.

Process Optimization & Automation

• 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.

Performance Monitoring & Reporting

• 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.

QUALIFICATIONS

Required

•  
• 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.

COMPETENCIES

• Operational Excellence & Process Discipline
• Billing Accuracy & Compliance Rigor
• Data-Driven Decision Making
• Cross-Functional Collaboration
• Team Leadership & Accountability

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Location: Remote
• Frequently required to sit; regularly required to talk/hear; regular use of computer and standard office equipment.
• Office environment with regular interaction across clinical, operational, and commercial stakeholders.
• Travel Requirements: Occasional travel may be required, such as onsite meetings, vendor or payer sessions, or operational reviews.

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.