JOB SUMMARY
The Manager, Revenue Cycle Management Clinical Support is responsible for establishing and leading a specialized clinical support function focused on prior authorizations and appeals for genetic testing services. This role builds and manages a small team of certified genetic counselors to ensure timely, accurate, and compliant revenue cycle support while improving access to testing and financial outcomes.
This role exists to operationalize a high-impact clinical revenue cycle function that supports patient access, payer compliance, and organizational financial performance. It impacts clinical operations, billing and finance partners, payers, and ordering providers. Success is measured by authorization turnaround times, appeal success rates, team performance, and the effective use of technology and AI-enabled workflows. The scope of this role may evolve as organizational needs change.
KEY RESPONSIBILITES
- Develop, implement, and manage a revenue cycle management clinical support function focused on prior authorizations and appeals for genetic testing services.
- Lead, coach, and develop a team of certified genetic counselors, establishing workflows, performance expectations, and quality standards.
- Oversee authorization and appeal activities to improve approval rates, reduce turnaround times, and support timely patient access to testing.
- Partner with billing, finance, laboratory operations, and payer strategy teams to align clinical support workflows with revenue cycle processes.
- Analyze authorization and appeal data to identify denial trends and implement process improvements.
- Leverage AI-enabled tools and automation to improve efficiency and scalability of revenue cycle workflows.
- Ensure compliance with payer policies, regulatory requirements, and internal quality standards.
- Perform other duties as assigned and comply with all company policies and procedures.
QUALIFICATIONS
Required
- Master of Science or Master of Arts in Genetic Counseling from an ACGC‑accredited program or equivalent.
- Board‑certified Genetic Counselor.
- Minimum of 5 years of professional experience as a genetic counselor, including experience supporting revenue cycle management activities such as prior authorizations and appeals.
- Minimum of 1 year of people management or team leadership experience.
- Demonstrated experience interpreting payer policies and supporting insurance authorization and appeals processes.
- Strong analytical, organizational, and communication skills.
- Equivalent combination of education and experience may be considered.
Preferred:
- Experience in a commercial genetic testing laboratory or healthcare diagnostics environment.
- Experience building or scaling a new functional team or service area.
- Experience using or implementing AI‑enabled tools, automation, or decision‑support technologies within clinical or revenue cycle workflows.
- Familiarity with revenue cycle systems, payer portals, and customer relationship management platforms.
COMPETENCIES
- Revenue cycle and payer policy expertise
- People leadership and team development
- Process design and operational execution
- Data‑driven decision making
- Technology and AI‑enabled workflow optimization
PHYSICAL DEMANDS AND WORK ENVIRONMENT
- Physical Demands: Ability to sit and stand for extended periods; frequent use of hand and finger dexterity; ability to speak, hear, and use visual acuity for reading and computer work.
- Work Environment: Office environment; occasional exposure to bloodborne or airborne pathogens or infectious materials.
- Travel Requirements: Occasional travel for training or meetings.
- Special Conditions: Compliance with clinical and laboratory safety requirements.
EEO Statement:
Baylor Genetics is proud to be an equal opportunity employer committed to fostering an inclusive and diverse workplace. We welcome and encourage applicants from all backgrounds to apply. We do not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, pregnancy, childbirth, or any other status protected by applicable federal, state, or local law. If you need an accommodation during the application process, please contact our Human Resources team.