• Submits timely, accurate invoices to payer for products and services provided • Understands the terms and fee schedule for all contracts for which invoices are submitted • Correctly determines quantities and prices for drugs billed • Verifies that the services and products are correctly authorized and that required documentation is on file • Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided • Evaluates payments received for correctness and applies payments accurately to the system • Verifies that payments received are correct according to the fee schedule • Applies the payment correctly to the patient account • Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment • Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service • Transfers payments belonging to other offices within 48 hours of receipt • Follows up on invoices submitted to ensure prompt and timely payment • Calls to verify that claims submitted were received and are in processing • Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame • Generates and mails statements and collections letters • Follows-up on all denials within 48 hours of receipt • Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule • Follows HIPPA guidelines when accessing and sharing patient information to maintain patient and business confidentiality

**Lab Services** - Serve as the primary revenue cycle liaison and strategic business partner to laboratory leadership, pathology providers, and specialized service line stakeholders. - Provide leadership and oversight of the laboratory and specialized service line accounts receivable follow-up team, ensuring timely resolution of outstanding claims and optimization of collections performance. - Develop, lead, and mentor the laboratory revenue cycle team while establishing performance expectations, accountability measures, and professional development opportunities. - Develop, monitor, and present KPI reporting to laboratory leadership, including Days in AR, denial trends, cash collections, reimbursement performance, turnaround times, and other key operational metrics. - Lead revenue cycle integration efforts for laboratory acquisitions, practice onboarding, and system conversions, including transitions from legacy EHR and billing platforms. - Partner with Revenue Cycle Leadership, Information Technology, Compliance, Finance, and Clinical Operations to identify and resolve operational issues impacting reimbursement, patient satisfaction, and overall financial performance. - Identify opportunities to improve operational workflows, reduce revenue leakage, and standardize laboratory revenue cycle processes across the organization. - Monitor payer performance and reimbursement trends and implement corrective action plans to improve financial outcomes. **Data Analytics & Performance Improvement** - Use data analytics to identify trends, risks, and opportunities related to revenue capture and reimbursement - Lead performance improvement initiatives that enhance charge capture accuracy and operational efficiency - Utilize data analytics to identify trends, reimbursement risks, denial patterns, and opportunities to improve laboratory revenue cycle performance. - Develop executive-level dashboards and KPI reporting that provide actionable insights for laboratory leadership and executive stakeholders. - Lead performance improvement initiatives that improve AR productivity, reimbursement outcomes, denial resolution, and operational efficiency. - Analyze revenue cycle metrics and recommend strategic process improvements that support organizational growth and scalability. **Collaboration & Clinical Partnership** - Collaborate with physicians, laboratory leadership, practice operations, Compliance, Finance, Information Technology, and Revenue Cycle leaders to improve documentation, charging practices, reimbursement, and operational effectiveness. - Support organizational growth through standardization of laboratory revenue cycle processes and best practices. - Serve as the subject matter expert for laboratory revenue cycle operations, reimbursement methodologies, coding support, and financial performance. - Build collaborative partnerships across departments to resolve complex revenue cycle issues and support enterprise initiatives affecting laboratory and specialized service lines. **Leadership & Team Development** - Lead, mentor, and develop a high-performing laboratory revenue cycle team focused on operational excellence and customer service. - Foster a culture of accountability, collaboration, continuous improvement, and professional growth. - Support workforce planning, succession planning, performance management, and employee development initiatives. - Lead organizational change efforts related to process improvements, technology implementations, and revenue cycle optimization initiatives.

Role Description The Director, Accounts Receivable, Laboratory & Specialized Services provides strategic and operational leadership for the laboratory and specialized service line accounts receivable (AR) function. This role is responsible for: - Optimizing AR follow-up processes - Resolving complex reimbursement issues - Improving collections performance - Reducing aging receivables - Driving operational excellence through KPI management, data analytics, and process improvement As the primary accounts receivable partner to laboratory leadership and pathology providers, the Director develops and executes strategies to: - Improve reimbursement outcomes - Reduce outstanding AR - Minimize revenue leakage related to unresolved claims - Enhance operational efficiency This role collaborates closely with Revenue Cycle Leadership, Finance, Information Technology, Compliance, and other RCM leaders to: - Streamline AR workflows - Leverage data-driven insights - Support system implementations - Improve financial performance across laboratory and specialized service lines The Director serves as the subject matter expert for laboratory and specialized service line accounts receivable operations, providing strategic leadership through: - Performance analytics - KPI reporting - Process optimization - Continuous improvement initiatives Qualifications - Minimum of 8 years of progressive Revenue Cycle Management experience within healthcare - Minimum of 5 years of leadership experience managing revenue cycle teams - Minimum of 3 years of experience in a large pathology laboratory setting - Significant experience supporting pathology, laboratory medicine, or other specialized healthcare service lines - Demonstrated success leading laboratory accounts receivable operations, denial resolution, reimbursement follow-up, payer escalations, and collections performance - Experience leading revenue cycle optimization initiatives within a multi-site healthcare organization - Proven ability to lead large-scale operational improvement and system implementation projects Requirements - Advanced knowledge of laboratory accounts receivable processes, reimbursement methodologies, payer requirements, denial management, and collections strategies - Experience with XiFin Practice Management strongly preferred - Experience with ModMed or comparable electronic health record and practice management systems preferred - Working knowledge of CPT, ICD-10, HCPCS, Medicare, Medicaid, commercial payer guidelines, and laboratory billing regulations - Advanced Microsoft Excel and reporting capabilities Leadership Competencies - Strategic leadership and executive presence - Financial and operational acumen - Strong analytical and problem-solving skills - Change management and process improvement expertise - Exceptional communication and relationship-building skills - Ability to influence cross-functional stakeholders and executive leadership - Strong organizational and project management skills Benefits - Competitive Pay – Attractive compensation to reward your hard work - Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered - Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting - Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year - Company-Paid Life Insurance – Peace of mind with basic life coverage, with the option for additional plans - Disability Protection – Short-term and long-term disability coverage to protect you in unexpected circumstances - Additional Wellness Plans – Accident, critical illness, and identity theft protection plans for extra security - Employee Assistance Program (EAP) – Access confidential support for personal or work-related challenges - Exclusive Employee Discounts – Save on products and services with special discounts just for you - Referral Bonus Program – Earn bonuses by referring qualified candidates to join the team Company Description QualDerm Partners is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Applicants must be currently authorized to work in the United States on a full-time basis.

• Investigate, appeal, and resolve denied or rejected claims by insurance payors. • Work with insurance companies to clarify discrepancies and ensure proper reimbursement. • Review and assess Explanation of Benefits (EOBs) at the claim level to determine issues. • Determine root cause of any billing related or claim submission issues to prevent recurrence. • Make corrections to claims based on denials and rebill utilizing standardized process and procedures. • Follow up with unresolved claims through system resources, clearinghouse, payer portal or call to the payor, when necessary. • Assess whether an appeal is required for a claim denial. • Track appeals to ensure timely payment and resolution. • Spot recurring patterns in denials and report them to management for further analysis and action. • Effectively communicate both verbally and in writing with team members, payors, patients, and other relevant parties. • Keep up to date with internal processes, industry standards, and government regulations relevant to denial management to ensure compliance and best practices.