Clinical Laboratory Revenue Cycle Manager (RCM) (Hybrid)

Job Description

Job Description

Description:

NOTE: This opportunity is open to full-time employment (no C2C or 1099 engagements, or third parties, please). The candidate MUST be authorized to work in the United States without sponsorship. local to the Macon GA metro area and available to be on-site in this hybrid role.

Daily Responsibilities

• Manage end-to-end clinical laboratory revenue cycle operations including charge capture, coding, billing, collections, and denial management.
• Supervise and train revenue cycle staff including Revenue Cycle Specialists and billing personnel.
• Ensure accurate CPT, ICD-10, and modifier coding for laboratory tests including molecular diagnostics and pharmacogenetic assays.
• Oversee payer reimbursement strategies for Medicare, Medicaid, and commercial insurers.
• Monitor key revenue cycle KPIs including days in AR, clean claim rate, denial rate, and reimbursement yield.
• Develop workflows and internal controls to ensure accurate billing and regulatory compliance.
• Work closely with laboratory operations, compliance, and finance teams to optimize reimbursement.
• Lead payer contract analysis and reimbursement modeling for new laboratory test offerings.
• Oversee appeals and resolution of complex denials.
• Ensure compliance with CMS billing rules, MolDx policies, and payer coverage determinations.
• Prepare financial and operational reports for executive leadership.

• Must be authorized to work in the United States without sponsorship.
• Must be within daily commuting distance to the Macon GA metro area to be on-site (hybrid schedule).
• 6+ years of clinical laboratory billing or healthcare Revenue Cycle Management (RCM).
• Strong knowledge of CPT, ICD-10, and laboratory billing requirements.
• Experience working with Medicare Administrative Contractors (MACs) and private payers.
• Demonstrated leadership and team management skills.
• Proven executive presence and cross-functional influence to achieve organizational goals.
• Knowledge of MolDx policies and laboratory coverage determinations.
• Experience with Laboratory Information Systems (LIS) and billing platforms.
• Proven financial acumen and data-driven decision making.
• Strong analytical and problem-solving skills in complex, ambiguous environments.
• BA/BS degree in healthcare administration, finance, business, or related field
• Experience scaling billing operations for high-complexity CLIA laboratories is a PLUS.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) is a PLUS.

Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, location, and other business and organizational needs.