Laboratory Billing Specialist / Revenue Cycle Manager (RCM)

We are seeking a highly experienced Laboratory Billing Specialist / RCM Manager to oversee and optimize all aspects of our diagnostic laboratory billing operations. This role will act as the internal billing authority, working closely with our third-party billing company to ensure clean claim submission, minimize denials, and maximize reimbursement.

The ideal candidate must have deep expertise in clinical laboratory billing, coding, payer guidelines, and denial management, and should be capable of identifying gaps, resolving issues, and implementing process improvements.

Key Responsibilities

• Oversee and audit the performance of the external billing company
• Review and ensure clean claim submission (first-pass resolution)
• Analyze and resolve denials (CO-45, CO-97, CO-16, PR-96, etc.)
• Identify root causes of denials and implement corrective workflows
• Monitor AR (Accounts Receivable) and aging reports
• Ensure proper usage of CPT codes, ICD-10 codes, modifiers (e.g., 59, 91, 25)
• Validate medical necessity compliance (LCD/NCD guidelines)
• Manage payer-specific requirements (Medicare, Medicaid, BCBS, Aetna, UHC, etc.)
• Work on eligibility verification and benefits investigation
• Review EOBs/ERAs and payment posting accuracy
• Ensure proper credentialing and enrollment (NPI, CLIA, PECOS, CAQH)
• Maintain compliance with HIPAA and CMS billing regulations
• Coordinate with lab operations for proper test coding & panel setup
• Optimize workflows for high-volume tests (CBC, CMP, Ferritin, Toxicology, etc.)
• Track rejection trends and clearinghouse errors
• Generate weekly/monthly billing performance reports
• Implement strategies to reduce write-offs and maximize collections

Required Skills & ExpertiseCore Billing Knowledge

• Strong understanding of Laboratory Billing (Clinical & Toxicology preferred)
• Expertise in:
• CPT / HCPCS coding
• ICD-10 diagnosis coding
• Modifiers usage
• Medical necessity rules
• Hands-on experience with:
• Denial Management & Appeals
• AR Follow-ups
• Insurance Verification
• Charge Entry & Payment Posting

Technical & System Skills

• Experience with LIS (Laboratory Information Systems) and billing software
• Familiarity with Clearinghouses (Office Ally, Change Healthcare, etc.)
• Knowledge of EDI transactions (837, 835, 270/271)
• Ability to audit data between LIS and Billing Systems
• Strong Excel / Google Sheets skills for reporting & analytics

Payer & Compliance Knowledge

• Experience handling:
• Medicare / Medicaid billing
• Commercial insurance (BCBS, Aetna, UHC, Cigna, etc.)
• Understanding of:
• LCD/NCD policies
• Frequency limitations
• Bundling & unbundling rules
• Familiarity with CLIA regulations for lab billing

Credentialing & Enrollment

• Experience with:
• Provider Enrollment (PECOS, CAQH)
• NPI registration and maintenance
• CLIA certification handling
• Ability to ensure lab is properly enrolled with all payers

Preferred Qualifications

• Experience working with high-complexity labs or toxicology labs
• Prior experience managing or auditing outsourced billing teams
• Knowledge of HL7 integrations and lab-machine workflows
• Certification such as:
• CPB (Certified Professional Biller)
• CPMA / CPC (AAPC)

Key Performance Indicators (KPIs)

• Reduction in denial rate (%)
• Increase in clean claim rate
• Improvement in AR days
• Recovery of underpaid / denied claims
• Accuracy in coding and billing compliance

Note: Candidates without hands-on lab billing experience will not be considered.

Job Type: Full-time

Pay: Rs150,000.00 - Rs200,000.00 per month

Application Question(s):

• How many years of US laboratory billing experience do you have?
• Have you worked with denial codes like CO-45, CO-97, CO-16, PR-96?
• Are you comfortable working onsite and night shifts (US hours)?

Work Location: In person