Revenue Cycle Director-Lab-Pre Submission

Job Description

Job Description

We are seeking an in person experienced Revenue Cycle Management Director (RCM) professional to support our

diagnostic laboratory specializing in women's health, toxicology, and genetic testing. This role

focuses on pre-submission, claim scrubbing, and coding accuracy, ensuring every claim is

clean, compliant, and optimized for timely reimbursement.

Responsibilities :

Review and scrub claims prior to submission to ensure all patient, provider,

CPT, and diagnosis information is accurate and complete.

Validate CPT and ICD-10 codes for accuracy and medical necessity in

accordance with payer and CMS guidelines.

Identify claim errors, discrepancies, or missing data and coordinate with

internal and external teams (including outsourced billing teams, sales reps,

clinical teams, phlebotomists, and lab IT) to correct and resubmit.

Maintain up-to-date knowledge of payer-specific policies, modifiers, LCD / NCD

coding rules, and compliance standards for molecular and diagnostic testing.

Work cross-functionally to ensure claims are optimized for clean submission

and prevent denials or delays.

Prepare summary reports and performance metrics for stakeholders and

leadership, highlighting recurring issues or process improvements.

Support internal training and provide feedback loops to ensure ongoing coding

accuracy and RCM process efficiency.

Qualifications :

2+ years of experience in Director level role in RCM, medical billing, or coding (laboratory

experience strongly preferred).

Strong working knowledge of CPT, ICD-10, and HCPCS coding, particularly

within molecular diagnostics, toxicology, and women's health.

Familiarity with claim scrubbing software, EHRs, and clearinghouses.

Understanding of payer policies, prior authorization workflows, and claim

submission protocols.

Experience collaborating with multi-departmental teams and external partners.

Certification such as CPC, COC, or equivalent preferred but not required.

Personal Skills :

Detail-oriented with strong analytical and problem-solving skills.

Excellent written and verbal communication.

Ability to manage multiple priorities and meet tight deadlines.

Proactive mindset with a passion for accuracy and compliance.

Self-driven, reliable, and comfortable working both independently and

collaboratively

Work Location : In person