Serum Billing Lead / Manager (RCM)

Serum Billing Lead / ManagerWe are seeking an experienced Serum Billing Lead / Manager to oversee and drive end-to-end Revenue Cycle Management (RCM) operations focused on serum, allergy, biologics, and specialty drug billing. This leadership role requires deep hands-on expertise in complex US healthcare reimbursement, along with the ability to build scalable workflows and support new client onboarding initiatives.The ideal candidate will serve as both a subject matter expert and operational leader—ensuring optimal reimbursement outcomes, reducing revenue leakage, and establishing standardized processes for serum and allergy billing across client accounts.Key ResponsibilitiesSerum & Allergy Billing Oversight (RCM Leadership)• Lead and oversee serum, allergy immunotherapy, biologics, and infusion-related billing operations.• Review and validate high-dollar claims including CPT, HCPCS (J-codes), ICD-10, modifiers, and NDC reporting.• Ensure accurate unit calculation, dosage validation, and payer-specific billing compliance.• Monitor clean claim rates and proactively address billing inefficiencies.• Serve as escalation point for complex billing issues and high-value denials.Denials Strategy & Revenue Optimization• Oversee resolution of denials related to medical necessity, prior authorization, eligibility, bundling, and reimbursement discrepancies.• Develop appeal strategies and guide the team in preparing strong supporting documentation.• Analyze denial trends and implement corrective action plans to improve overturn rates and cash recovery.• Drive measurable improvements in AR performance and reimbursement accuracy.SOP Development & Process Standardization• Create, document, and implement standardized SOPs, playbooks, and workflows for serum and allergy billing.• Develop billing guidelines for new client implementations.• Ensure process alignment with payer policies, CMS regulations, and compliance standards.• Continuously improve operational processes to enhance scalability and efficiency.Client Onboarding & Implementation Support• Participate in onboarding new clients with serum and allergy services.• Conduct workflow assessments and gap analyses during implementation.• Customize billing workflows based on specialty, payer mix, and documentation requirements.• Provide training and transition support to billing teams during go-live phases.Cross-Functional Collaboration & Leadership• Partner with coding, authorization, clinical, and front-end teams to reduce systemic denial drivers.• Communicate documentation improvement opportunities to providers and stakeholders.• Provide mentorship, guidance, and quality oversight to billing team members.• Assist in performance tracking through KPIs, dashboards, and revenue reporting.Qualifications• 5–10+ years of US healthcare Revenue Cycle Management experience with strong focus on serum, allergy, infusion, biologics, or specialty drug billing.• Demonstrated leadership or lead-level experience within RCM operations.• Advanced knowledge of J-code billing, NDC reporting, and high-dollar claim management.• Strong understanding of Medicare LCD/NCD policies and commercial payer reimbursement guidelines.• Proven expertise in denial resolution, appeal strategy, and revenue optimization.• Experience creating SOPs, workflows, and training materials.• Hands-on experience supporting client onboarding or practice transitions.• Experience with EHR/Practice Management systems (eClinicalWorks, Athena, Epic, or similar platforms).• Strong analytical, organizational, leadership, and communication skills.• Ability to manage multiple priorities in a fast-paced, performance-driven environment. Yochana