Revenue Cycle Director-Lab-Pre Submission

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.

• 2+ years of experience 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.

• 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