Revenue Cycle Management Operations Lead

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Take the lead in establishing revenue cycle operations for a newly launched market by researching payer requirements, workflows, billing processes, and reimbursement guidelines.

• Create, document, and implement standard operating procedures (SOPs), workflows, and operational best practices to facilitate future team expansion.

• Investigate and interpret the Medicaid billing requirements for Georgia and New Jersey, identifying the operational needs essential for compliance and reimbursement.

• Collaborate with leadership to define team structure, operational processes, performance metrics, and future key performance indicators (KPIs) as the department grows.

• Identify process inefficiencies and recommend solutions to enhance operational efficiency and improve future revenue cycle performance.

• Initially function as an individual contributor while laying the groundwork for the department.

• Transition into a leadership role as the Georgia and New Jersey markets expand, which includes hiring, training, coaching, and managing billing team members.

• Offer mentorship, onboarding assistance, and performance coaching to future team members.

• Supervise the preparation, submission, and follow-up of insurance claims for home health care services.

• Ensure accurate coding (CPT, HCPCS, ICD-10) and compliance with payer-specific guidelines.

• Promptly monitor and resolve claim rejections, denials, and underpayments.

• Manage accounts receivable to minimize outstanding balances and maximize collections.

• Ensure billing practices adhere to federal, state, and payer-specific regulations, including Medicare and Medicaid guidelines.

• Keep abreast 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 enhance efficiency and reduce errors.

• Work collaboratively with other departments to address issues impacting the revenue cycle, such as intake and documentation workflows.

⛳️ Requirements

• A high school diploma or equivalent is required; an Associate’s or Bachelor’s degree in a related field is preferred.

• A minimum of 3-5 years of experience in medical billing, with at least 1-2 years in a supervisory or leadership position.

• Demonstrated expertise in home health care billing, including Medicare and Medicaid processes.

• Experience in building, implementing, or enhancing billing processes and operational workflows is strongly preferred.

• Experience with Georgia and New Jersey Medicaid billing is a significant advantage.

• Candidates with billing experience in Home Health, Hospice, or Skilled Nursing will be considered.

• Intermediate proficiency in Microsoft Excel is preferred.

• Certification as a Certified Professional Biller (CPB) or an equivalent credential is preferred.

🏝️ Benefits

• Competitive compensation packages that reflect the value you contribute.

• Comprehensive health coverage tailored to your needs.

• Choose from high-quality medical, dental, and vision plans, including a $0 deductible PPO and a company-funded HSA, along with 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.