Senior Director of Revenue Cycle Management

About Us

Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.

Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.

Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike.

Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company.

Summary of Position

The Senior Director of Revenue Cycle Management leads the billing, collections, and accounts receivable team while maintaining a comprehensive understanding of the company's billing systems and all aspects of revenue cycle management within a high-volume diagnostics laboratory environment. This leader manages the centralized billing staff through daily supervision while overseeing all billing, eligibility, and benefits investigation functions.

As a key leader in a publicly traded company, the Senior Director is responsible for ensuring that all revenue cycle operations adhere to compliance requirements which include HIPAA (patient privacy), False Claims Act (billing accuracy), Anti-Kickback Statute, Stark Law and internal control processes for a publicly traded company. The Senior Director establishes the overall framework for a robust billing and collection process supported by internal controls, audit trails, and documentation for billing audits.

This role executes and implements strategic goals for each location through the utilization of their management team, directing and planning daily workflow activities for billing staff members.

Key Job Elements

Revenue Cycle Operations & Billing Management

• Direct billing management and staff to ensure accurate submission of all claims and timely collections in accordance with all third-party contract terms including Medicare, Medicaid, managed care, commercial insurance, and direct patient pay.
• Lead the end-to-end diagnostics laboratory revenue cycle lifecycle - from test order and specimen receipt through charge capture, claim submission, adjudication, payment posting, denial resolution, and final collections.
• Establish and maintain all billing and financial data, including medical billing code tables, rate schedules, and payer information.
• Analyze reimbursement from all sources, including carrier reimbursement exception reporting, follow-up of pending claims, and denials management.
• Assure maximization of cash collections through diligent and timely monitoring of all open accounts receivable balances.
• Maintain and enhance billing policies and procedures for each function in the revenue cycle process and ensure staff adherence to policies.
• Manage continuous improvements within the revenue cycle process, leveraging Quadax's workflow automation and claim scrubbing and clearinghouse capabilities.

Benefits Investigation & Patient Access

• Establish close partnership with Client Services team on all benefits investigation (BI) processes to ensure accurate determination of patient eligibility, out-of-pocket liability, and payer authorization requirements prior to and post testing.
• Establish and enforce comprehensive BI workflows that reduce claim denials related to eligibility, medical necessity, and prior authorization.
• Collaborate with laboratory operations and client services teams to align order intake processes with BI findings to minimize downstream billing failures.
• Develop and maintain payer-specific BI protocols for high-complexity assays including molecular diagnostics, genomics, and specialty pathology panels.
• Ensure benefits investigation teams are trained on payer-specific documentation requirements and have access to current payer policies.

SOX Compliance & Internal Controls

• Serve as the revenue cycle subject matter expert for SOX compliance, ensuring that all billing and collections processes meet the internal control requirements of a publicly traded company.
• Design, document, and maintain internal controls over financial reporting (ICFR) for all revenue cycle functions, including charge capture, cash posting, adjustments, refunds, and AR reserves.
• Partner with Finance, Internal Audit, and external auditors to support quarterly and annual SOX testing activities.
• Ensure segregation of duties is enforced across all revenue cycle functions to prevent fraud and errors.
• Maintain comprehensive audit trails and documentation within Quadax systems to support SOX testing and external audit requests.
• Monitor and respond to revenue cycle control deficiencies identified through internal or external audit processes and lead any necessary remediation activities.
• Lead preparation of revenue cycle-related disclosures and schedules required for SEC financial reporting, including AR aging, bad debt reserves, and collectability assessments.

Systems Management - Quadax

• Serve as the primary organizational owner and subject matter expert for Quadax RPM (Revenue Cycle Management), driving system optimization, workflow configuration, and integration with laboratory information systems (LIS).
• Manage the Quadax vendor relationship for clearinghouse, claim editing, denial management, and outsourced billing services; hold vendor accountable to SLA performance metrics and contractual obligations.
• Lead system enhancement projects within Quadax to improve automation, reduce manual intervention, and accelerate cash collection cycles.
• Collaborate with IT and Quadax support to troubleshoot system issues, manage upgrades, and ensure data integrity across billing and LIS platforms.
• Design and maintain Quadax-based reporting dashboards to monitor KPIs, payer performance, denial trends, and staff productivity in real time.

Financial Reporting & Analytics

• Prepare detailed analyses and reports of billing and accounts receivable activity and results, including performance metrics, bad debt expense, and AR days outstanding.
• Actively collaborate with the Finance team on analysis of billing activity for monthly financial close, quarterly reporting, and annual budget planning.
• Present revenue cycle performance dashboards and variance analyses to senior leadership and the CFO on a regular cadence.

People Leadership & Organizational Development

• Leads a high-performance team of 50+ staff responsible for data entry, CPT and ICD-10 coding, cash posting, denial and accounts receivable management, refunds processing, benefits investigation, and call center operations.
• Recruit, hire, train, and develop billing leaders and staff. Provide direction through daily coaching, performance management, and individualized development plans.
• Conduct annual performance evaluations, make compensation recommendations, and develop corrective action plans when necessary.
• Manage all outreach billing operations including hiring, orientation, training, and ongoing monitoring of staff work-related activities.
• Provide educational opportunities for staff pathologists and clinicians regarding coding matters and compliance requirements.

Compliance, Policy & Vendor Relations

• Participate in the Compliance Committee for coding and billing-related items; establish and enforce departmental and company policies and procedures.
• Interface with third-party payers to resolve reimbursement issues and provide guidance to senior leadership regarding contracting challenges.
• Launch, manage, and monitor integration initiatives for new billing locations and acquired entities.
• Promote organizational efficiency, identify automation opportunities, and lead continuous quality improvement initiatives.

Knowledge/Experience

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field required.
• Master's degree (MBA, MHA) or CPA designation preferred.
• Certified Professional Coder (CPC), Certified Revenue Cycle Professional (CRCP), or equivalent certification strongly preferred.
• Ten (10) - fifteen (15) years of progressive revenue cycle leadership experience, with a minimum of 8 years managing a high-volume billing operation within a diagnostics laboratory, clinical laboratory, or pathology setting.
• Demonstrated expertise in the full diagnostics laboratory revenue cycle lifecycle, from test order intake and eligibility verification through claim submission, adjudication, denial management, and final collections.
• Extensive hands-on experience with Quadax RPM as the primary laboratory billing system, including system configuration, reporting, and workflow management.
• Extensive experience managing Quadax as a clearinghouse/billing vendor partner, including SLA oversight, denial management workflows, and outsourced billing coordination.
• Proven experience with benefits investigation processes in a laboratory or diagnostics setting, including prior authorization workflows and payer-specific BI requirements for high-complexity molecular and genomic assays.
• Direct experience with SOX compliance in a publicly traded company environment, including design and testing of revenue cycle internal controls over financial reporting (ICFR).
• Demonstrated leadership of teams of 75+ employees in a multi-site environment.
• Deep knowledge of CPT and ICD-10 coding for anatomic pathology, molecular diagnostics, and laboratory services.
• Extensive knowledge of Medicare, Medicaid, and commercial payer billing regulations, LCD/NCD policies, and laboratory-specific coverage requirements.

Preferred Skills & Competencies

• Capacity to actively engage and communicate with a wide variety of employees, senior leaders, and external auditors to drive change and problem solve.
• Skilled in researching, interpreting, and presenting complex data concisely to executive and Board-level audiences.
• Strong command of financial reporting, AR reserve analysis, and revenue recognition principles relevant to laboratory billing.
• Active, visible, and influential leadership style - directly engages, arrives at conclusions, drives consensus, and monitors actions in support of quality outcomes.
• Personable, persuasive, and comfortable navigating all levels of the workforce, from front-line billing staff to C-suite executives and external auditors.
• Proficient verbal and written communication skills with a demonstrated willingness to share and receive information and ideas from all levels of the organization.

Supervisory Responsibilities

• Yes

Reports To

• Vice President of Finance

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term "qualified individual with a disability" means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.

At Inform Diagnostics, we celebrate, support, and thrive on our differences. We are proud to be an equal opportunity workplace and an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status.

This description only includes the general content for this job and does not restrict the company from assigning or reassigning duties or responsibilities at any time.

Please note that Fulgent (and its affiliated companies, including Inform Diagnostics and CSI Laboratories) does not accept unsolicited information and/or resumes from search firms or agencies for our job postings. Search firms or agencies without an applicable contract and/or express approval to recruit for the role in question - that choose to submit a resume or client information to our career page or to any employee of Fulgent - will not be eligible for payment of any fee(s), and any associated shared data will become the property of Fulgent.