Senior Manager, RCM

Senior Manager, Revenue Cycle Management

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.

Knowledge / Experience

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.