Baylor Genetics is seeking a Senior Director, Revenue Optimization and Reporting responsible for leading a team and developing scalable end-to-end billing processes. The role involves ensuring accurate and timely benefit investigations, prior authorizations, insurance claims submissions, appeals, patient, and client billing. The ideal candidate should have a strong ability to build professional relationships, drive accountability, and lead change. Exceptional knowledge of health plan behaviors in reimbursement and denials is essential, with preference for experience in billing operations at molecular diagnostic or genetic testing companies.

• Work closely with internal stakeholders and business partners to develop scalable billing systems and processes, implementing improvements supporting revenue cycle goals.
• Develop and implement best practice methodology for billing system and process optimization.
• Collaborate with senior leaders, sales, and clinical staff to effect change in systems and processes.
• Partner with Finance to evaluate and recommend optimal revenue cycle organizational structure and standard metrics for monitoring revenue recognition.
• Work closely with Finance, Commercial Operations, and third-party billing vendor to monitor trends in denials, appeals, and revenue.
• Proactively ensure compliance with federal, state, and local legal requirements, researching legislation, consulting with outside advisors, and filing financial reports.
• Ensure consistent and actionable communication with key customers.
• Provide reporting and feedback to various departments for correct coding and billing of patient accounts.
• Experience in a complex shared service environment with multiple reporting relationships.
• Experience managing complex/large-scale/transformational projects, including demonstrated success in coordinating major projects.
• Knowledge of all payer types, related healthcare terminology, and institutional billing.

• BA/BS in Accounting or Finance preferred, or equivalent work experience.
• Knowledge of CPT coding, ICD-9 and ICD-10, with previous experience working in laboratory billing, including Medicare and Medicaid.
• 15+ years’ experience with a minimum of 7 years in billing operations and leadership in healthcare.
• Leadership and startup experience in medical billing and revenue cycle is required.
• Understanding of the claim submission process and ability to verify the transmission of electronic claims.
• Knowledge of standard healthcare remark and reason codes driving denials.
• Knowledge of Medicare billing policies, including modifiers, NCD, and LCD.
• Experience working with sensitive patient information.
• Ability to interpret various explanations of benefits (“EOB”) from insurance companies.
• Understanding of medical and insurance terminology.
• Ability to influence via communication and interpersonal skills.
• Ability to handle a wide work variety in a fast-paced environment.
• Meticulous, organized, self-starting, with an ability to prioritize workload.
• Compliance, Law & Ethics (HIPAA) knowledge is preferred.
• Experience with third-party laboratory billing software is highly desired.