Manager, Revenue Cycle Management Eligibility

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 conferences

EEO Statement

Baylor 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