The Manager, Revenue Cycle Management – Eligibility is responsible for leading the Eligibility team and overseeing insurance verification, payer coverage assessment, and interpretation of patient out-of-pocket costs. This role ensures operational efficiency, accuracy, and compliance while continuously improving processes and team performance. The Manager will collaborate with internal teams, maintain high service standards, and drive strategic improvements in eligibility-related operations.
Duties and Responsibilities
- Manage all day-to-day operations of the eligibility function, ensuring accurate and timely verification of patient insurance
- Lead hiring, onboarding, training, coaching, and performance evaluations of team members
- Develop and implement workflows to improve sub-team productivity and reduce claim denials
- Monitor performance metrics (KPIs) and report outcomes to senior leadership
- Maintain compliance with payer requirements, industry regulations, and HIPAA standards
- Collaborate with cross-functional teams and external vendors to address eligibility challenges and optimize patient access
- Conduct regular audits of eligibility processes to identify improvement opportunities
- Maintain accurate and up-to-date documentation, including workflows, training guides, and client-facing resources
- Use visual tools such as Visio, Canva, Lucid, or Figma to build dynamic and easy-to-understand training materials
- Engage in root cause analysis and trend reporting to address frequent eligibility-related denials
- Ensure team compliance with the Baylor Genetics Code of Conduct and company standards
Skills and Competencies
- Strong knowledge of payer guidelines, eligibility verification, and healthcare reimbursement
- Excellent verbal and written communication with the ability to simplify complex insurance-related topics
- Proficiency in Microsoft Office Suite and design tools such as Canva, Lucid, Visio, Miro, or Figma
- Document editing and training development experience
- Strong leadership and team development skills
- Analytical and results-oriented with strong organizational capabilities
- Ability to work effectively cross-functionally and in a fast-paced, dynamic environment
Education:
- Bachelor’s degree preferred; equivalent combination of education and experience accepted
Experience:
- Minimum 5 years of experience within Revenue Cycle Management, with a strong focus on eligibility, prior authorizations, and clinical operations
- 5–7 years of experience in a healthcare or diagnostic laboratory setting preferred
- Experience creating and maintaining training documentation, SOPs, and job aids
- Leadership experience in team management or training preferred
Physical Demands and Work Environment
· Frequently required to sit, speak, and use standard office equipment· Occasionally required to travel for training, client meetings, or conferencesEEO StatementBaylor Miraca Genetics is proud to be an equal opportunity employer committed to building an inclusive and diverse workforce. We do not discriminate based on race, religion, color, national origin, sex, sexual orientation, age, gender identity, veteran status, disability, genetic information, pregnancy, childbirth, or any other status protected under applicable federal, state, or local law
