abby-care - Revenue Cycle Management Operations Lead
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Requirements
• Education: High school diploma or equivalent required; Associate’s or Bachelor’s degree in a related field preferred. • Minimum 3-5 years of experience in medical billing, with at least 1-2 years in a supervisory or leadership role. • Proven expertise in home health care billing, including Medicare and Medicaid processes. • Experience building, implementing, or improving billing processes and operational workflows is strongly preferred. • Georgia and New Jersey Medicaid billing experience is a significant advantage. • Candidates with Home Health, Hospice, or Skilled Nursing billing experience will be considered. • Intermediate Microsoft Excel proficiency preferred. • Certifications: Certified Professional Biller (CPB) or equivalent preferred. • Excellent organizational, analytical, and problem-solving abilities. • Exceptional communication and interpersonal skills to lead a team and collaborate across departments. • Strong research and investigative skills with the ability to gather information independently in a newly established market. • Demonstrated accountability, including ownership of mistakes, problem resolution, and continuous improvement. • Strong conflict resolution, coaching, and delegation skills. • Ability to build processes and operate effectively in an ambiguous, startup-like environment.
Responsibilities
• 1. New Department Development • Lead the establishment of revenue cycle operations for a newly launched market, including researching payer requirements, workflows, billing processes, and reimbursement guidelines. • Develop, document, and implement SOPs, workflows, and operational best practices to support future team growth. • Research and interpret Georgia and New Jersey Medicaid billing requirements and identify operational requirements necessary to support compliance and reimbursement. • Partner with leadership to define team structure, operational processes, performance metrics, and future KPIs as the department scales. • Identify process gaps and recommend solutions to improve operational efficiency and future revenue cycle performance. • 2. Team Leadership: • Initially operate as an individual contributor while building the foundation of the department. • Transition into a people leadership role as the Georgia and New Jersey markets expand, including hiring, training, coaching, and managing billing team members. • Provide mentorship, onboarding support, and performance coaching to future team members. • Experience conducting performance reviews is highly preferred. • 3. Billing Operations: • Oversee the preparation, submission, and follow-up of insurance claims for home health care services. • Ensure accurate coding (CPT, HCPCS, ICD-10) and adherence to payer-specific guidelines. • Monitor and resolve claim rejections, denials, and underpayments promptly. • Manage accounts receivable to minimize outstanding balances and maximize collections. • 4. Compliance and Documentation: • Ensure billing practices comply with federal, state, and payer-specific regulations, including Medicare and Medicaid guidelines. • Maintain up-to-date knowledge of changes in billing rules and home health care regulations. • Review documentation for accuracy and completeness to support submitted claims. • 5. Process Improvement: • Analyze billing processes and implement strategies to improve efficiency and reduce errors. • Collaborate with other departments to address issues impacting the revenue cycle, such as intake and documentation workflows.
Benefits
• Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus. • Comprehensive health coverage that works for you. Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance. • Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays. • Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered). • Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows.
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