Revenue Cycle Specialist

Overview

A growing genomics organization is seeking a detail-oriented Revenue Cycle Specialist to join their Revenue Cycle Management (RCM) team. This hands-on role focuses on claim and denials management, appeals, and administrative tasks essential to maintaining an efficient billing operation. The specialist will work extensively within RCM systems, payor portals, and clearinghouses to manage claims, resolve denials, and maximize revenue.

This position is well suited for candidates with laboratory or diagnostic billing experience who want to take ownership of meaningful work in a fast-growing genomics environment. The role reports directly to the Head of Revenue Cycle Management and involves close collaboration with a small, focused team.

Responsibilities

• Manage day-to-day claim and denials processing across the organization’s book of business using RCM systems and payor portals.
• Investigate and resolve front-end and back-end rejections and denials, identify root causes, and collaborate with internal teams to prevent recurrence.
• Draft, submit, and track appeals for commercial and government payors, including out-of-network claims, ensuring strong documentation and follow-through.
• Handle denials related to prior authorization, medical necessity, timely filing, eligibility, coordination of benefits, and non-covered services; escalate systemic issues with proposed solutions.
• Navigate clearinghouses such as Change Healthcare/Optum and Availity, verify eligibility, check claim status, and retrieve Explanation of Benefits (EOBs) and remittance details.
• Perform administrative billing tasks including demographic and insurance corrections, claim resubmissions, payor follow-up calls, and documentation uploads.
• Maintain detailed notes and worklog hygiene in the RCM system to ensure clear audit trails for all claims.
• Identify trends in denial reasons, payor behavior, and process gaps; report findings and suggest workflow improvements to leadership.
• Collaborate with Customer Support, Clinical Operations, and Laboratory teams to address upstream issues causing downstream denials.

Requirements

• 2–5 years of revenue cycle, billing, or claims experience in a laboratory, diagnostic, or genetic testing environment; experience at a peer lab is a strong plus.
• Hands-on experience with Xifin preferred; familiarity with other lab RCM systems or clearinghouses (Change Healthcare/Optum, Availity, payor portals) also considered.
• Proven experience managing claims for out-of-network providers with commercial payors.
• Working knowledge of front-end and back-end rejections and denials, with a successful track record of appeals.
• Required knowledge of denial categories including:
  • Prior authorization
  • Medical necessity
  • Timely filing
  • Eligibility
  • Coordination of benefits
  • Non-covered services
• Strong attention to detail and ability to manage high volumes of detailed administrative tasks accurately.
• Proactive, high-energy approach with the ability to take initiative and close loops independently.
• Excellent written and verbal communication skills, including the ability to write clear and persuasive appeal letters.
• Comfortable working in ambiguous situations and willing to contribute hands-on in a small, fast-paced team.
• Proficient with Google Workspace, Excel, and modern RCM/billing tools.

Compensation & Benefits

• Location: Remote within the United States
• Salary Range: $70,000 - $90,000 annually, based on experience

Benefits

• Comprehensive healthcare coverage including health, dental, and vision
• 401(k) retirement plan
• Unlimited paid time off
• Professional development opportunities
• Company-sponsored off-sites and team meals during in-person meetings
• Direct access to company leadership and opportunities for career growth

Location

• Remote (United States only)