Revenue Cycle Management Operations Lead

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🔥 13 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $75k - $95k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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Abby Care

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

👥 B2C

Healthcare Insurance • B2C

Abby Care is a service that helps families get paid for providing in-home care to loved ones with disabilities or special needs. The organization trains and certifies family caregivers at no cost, manages hiring and payroll, navigates Medicaid and insurance paperwork to secure payment, and provides a purpose-built platform, clinical support, and community resources. Abby Care operates in multiple U. S. states and focuses on enabling high-quality, compensated family caregiving through partnerships with insurers and Medicaid programs.

📋 Description

• 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. • 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. • 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. • 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. • 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.

🎯 Requirements

• 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. • Certified Professional Biller (CPB) or equivalent preferred.

🏖️ Benefits

• Competitive compensation packages that reflect the value you bring. • 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. • 10 paid company holidays. • Financial savings benefits to support your future. • 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.