Senior Manager, RCM

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 Managementis 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.

Knowledge/Experience

• Bachelors 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.

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.

Please note that Fulgent (and its affiliated companies including Inform Diagnostics and CSI Laboratories) does not accept unsolicited information and/or resumes from search firms or agencies for our job postings. Search firms or agencies without an applicable contract and/or express approval to recruit for the role in question that choose to submit a resume or client information to our career page or to any employee of Fulgent will not be eligible for payment of any fee(s) and any associated shared data will become the property of Fulgent.