Lighthouse Lab Services is currently seeking a Revenue Cycle Manager in the Miami, FL area to oversee all revenue cycle operations for a CLIA-certified molecular diagnostics laboratory. This includes managing the complete billing lifecycle—from patient intake and prior authorizations to claim submission, reimbursement, and collections. The Manager will ensure that all billing practices for molecular and genetic testing services are compliant with evolving federal and payer-specific regulations. This role requires deep understanding of molecular CPT coding, prior authorization workflows, and third-party payer intricacies related to high-complexity laboratory testing.
The Manager will ensure accurate and timely billing, reduce days in accounts receivable, and maximize reimbursements. This individual will also collaborate closely with laboratory operations, research teams, compliance, and commercial staff to align financial goals with operational excellence.
Key Responsibilities:
Develop and execute revenue cycle strategies tailored to the complexities of molecular diagnostics, including genetic, PCR, and NGS testing.
Oversee all RCM operations including patient intake, benefits verification, prior authorization, coding, billing, payment posting, and denial management.
Ensure proper use of CPT and HCPCS codes for molecular and genetic tests, staying updated on AMA and CMS changes.
Work with payers to manage and negotiate molecular test reimbursement, including appeals and supporting documentation requirements.
Monitor KPIs such as clean claim rate, denial rate, days in A/R, net collection rate, and reimbursement per test.
Ensure full compliance with CLIA, HIPAA, OIG, CMS, and commercial payer policies.
Partner with IT and LIMS teams to ensure data accuracy and seamless claim workflows.
Provide strategic input on pricing, payer policy trends, and coverage analysis for new and existing test offerings.
Lead and mentor revenue cycle staff, focusing on training, development, and performance.
Support financial forecasting and reporting for senior leadership.
Qualifications:
Education:
Bachelor’s degree in healthcare administration, business, finance, or related field required.
Master’s degree (MBA, MHA, or equivalent) preferred.
Experience:
Minimum of 5–8 years of progressive experience in revenue cycle management, ideally in a molecular or clinical lab setting.
At least 1–3 years of experience in a leadership or manager-level RCM role.
In-depth understanding of molecular test coding, Z-Codes, and insurance pre-authorization processes.
Experience working with commercial payers and Medicare/Medicaid on complex lab test reimbursement.
Familiarity with LIMS, EHR systems (Collaborative MD preferred), and lab billing platforms.
Skills & Competencies:
Deep knowledge of payer policies and molecular reimbursement challenges.
Strong leadership and team development abilities.
Analytical thinker with proficiency in revenue cycle reporting and financial metrics.
Effective communicator with experience working cross-functionally with laboratory and commercial teams.
Ability to drive process improvement and implement RCM best practices in a dynamic environment.
Working Conditions:
Occasional travel may be required.
This position is based in Miami with hybrid remote flexibility.
Work involves frequent collaboration across clinical, research, and operational teams.
Compensation + Benefits:
About Us:
At Lighthouse Lab Services, we offer solutions to help start, grow, and run clinical laboratories. Our recruiting team has over 21 years of proven success placing job seekers in positions ranging from entry level Medical Technologists to seasoned Laboratory Directors. We recruit nationwide, for permanent and travel positions with clients ranging from small hospitals to large reference laboratories.
It is the policy of Lighthouse Lab Services to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Lighthouse Lab Services will provide reasonable accommodations for qualified individuals with disabilities.
Lighthouse Lab Services - 800-838-0602 lighthouselabservices.com
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