Job Description & Details
This is a hands-on functional SME role focused entirely on fixing the Order-to-Cash pipeline for a laboratory setting. If you know how to stop revenue leakage in healthcare billing and turn messy payer workflows into clean claims, this gig will let you make an immediate, measurable impact.
What You'll Actually Be Doing
You'll be auditing and optimizing the entire lifecycle from the moment a lab order drops in via EHR/CPOE all the way to cash posting and A/R collection. Your days will involve tracking down denial drivers, fixing front-end eligibility and prior-auth gaps, and figuring out why claims are getting stuck in payer edit loops. You'll spend plenty of time running workshops and collaborating with IT, billing teams, and lab stakeholders to map out the current state and push through real structural fixes.
The Core Tech Stack
You need deep, battle-tested expertise in laboratory billing and healthcare Revenue Cycle Management, particularly with EHR platforms like Epic, Cerner, or Meditech. Mastery over front-end workflows—demographics, insurance verification, medical necessity—combined with back-end denial management and root-cause analysis is non-negotiable here. Knowing LIS (Laboratory Information Systems) and US payer reimbursement rules inside and out will separate you from other applicants.
Interview Expectations
Expect the hiring team to present a realistic scenario where clean-claim rates drop sharply following a new lab test launch, and they will want to hear your step-by-step framework for tracing the issue back through charge capture, coding, and front-end order entry. They are secretly testing whether you can actually talk shop with both deep technical IT folks and business stakeholders without getting lost in the weeds. Be ready to explain how you handle pushback from lab directors when their intake workflows need a complete overhaul.
Application Advice
Skip the generic corporate summary and immediately highlight your specific accomplishments in laboratory RCM, specifically numbers around denial reduction and clean-claim improvements. Make sure to sprinkle in keywords straight from the requirements like Order-to-Cash, prior authorization, EHR/CPOE workflows, and root-cause analysis so you easily clear the ATS screening phase.