The RoleThis role will initially function as a hands-on Revenue Cycle Management (RCM) Lead responsible for establishing billing operations for a newly launched Georgia and New Jersey market. The successful candidate will build processes, conduct payer and regulatory research, create SOPs, and lay the foundation for a scalable RCM department. As the market grows, this role will evolve into a formal people leadership position overseeing billing specialists and offshore team members.
Key Responsibilities:- 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.
- 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.
- 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.
- 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.
- 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.
The Requirements:- Education: High school diploma or equivalent required; Associate's or Bachelor's degree in a related field preferred.
- Experience:
- 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.
- Skills:
- 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.
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.
