[Hiring] National Home Health RCM & Credentialing Manager @DHVAJ

Role Description

MDOfficeManager is seeking an experienced National Home Health RCM & Credentialing Manager with a minimum of three years of hands-on experience in adult home health care, home health billing, healthcare credentialing, and nationwide licensing operations. The ideal candidate will have a strong understanding of home health revenue cycle management, insurance billing, provider credentialing, payer enrollment, and state-specific licensing requirements across the United States.

This individual will oversee revenue cycle operations, coordinate nationwide credentialing and licensing activities, ensure compliance with applicable regulatory and payer requirements, and implement strategies to improve reimbursement performance and operational efficiency.

The successful candidate must have practical experience managing home health billing and coordinating credentialing and licensing requirements across multiple U.S. states.

Qualifications

• Minimum of three years of hands-on experience in adult home health care or home health operations.
• Minimum of three years of experience in home health billing and revenue cycle management.
• Minimum of three years of experience in healthcare credentialing, payer enrollment, and licensing coordination.
• Demonstrated experience managing or coordinating nationwide healthcare licensing and credentialing requirements across multiple U.S. states.
• Strong knowledge of Medicare, Medicaid, Medicare Advantage, and commercial insurance billing.
• Experience with home health claims processing, denial management, reimbursement, and accounts receivable.
• Working knowledge of provider credentialing, payer enrollment, license applications, and renewal processes.
• Understanding of state-specific healthcare regulations and applicable home health licensing requirements.
• Experience with electronic health records, medical billing platforms, and credentialing or licensing management systems.
• Strong organizational, analytical, communication, and problem-solving skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced healthcare environment.

Requirements

• Oversee the complete revenue cycle for adult home health services, including insurance verification, claims submission, payment posting, accounts receivable, collections, and reimbursement.
• Manage billing operations for Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
• Monitor revenue cycle performance and implement strategies to improve cash flow and reimbursement timelines.
• Analyze billing discrepancies, identify revenue leakage, and implement corrective measures.
• Track key performance indicators, including days in accounts receivable, claim denial rates, collection rates, and clean claim rates.
• Ensure accurate and timely submission of home health claims in accordance with applicable payer requirements.
• Oversee denied, rejected, and underpaid claims and coordinate appeals and corrected claims.
• Review billing documentation to ensure compliance with applicable reimbursement guidelines.
• Collaborate with clinical and administrative teams to resolve documentation issues affecting claims processing.
• Maintain knowledge of Medicare, Medicaid, and commercial insurance billing requirements applicable to home health services.
• Identify trends in claim denials and implement strategies to reduce billing errors and improve reimbursement.
• Oversee healthcare credentialing and payer enrollment activities for applicable providers and healthcare organizations operating nationwide.
• Manage credentialing applications, recredentialing, enrollment updates, renewals, and supporting documentation.
• Coordinate enrollment with Medicare, Medicaid, and commercial insurance payers, as applicable.
• Track credentialing status, application progress, approval dates, and renewal deadlines.
• Communicate with insurance companies, credentialing organizations, and regulatory agencies to resolve application delays.
• Maintain accurate credentialing records and establish standardized workflows for nationwide operations.
• Coordinate and oversee applicable healthcare licensing and regulatory requirements for operations across the United States.
• Manage licensing applications, renewals, expirations, and supporting documentation for applicable healthcare professionals and organizations.
• Research and monitor state-specific licensing requirements relevant to adult home health services and the organization's operating model.
• Maintain a centralized tracking system for licensing status, renewal deadlines, and outstanding regulatory requirements.
• Coordinate with state licensing boards and regulatory agencies as needed.
• Identify potential licensing and compliance gaps and communicate issues to leadership.
• Ensure applicable licensing and enrollment requirements are addressed before operations or services begin in a jurisdiction.
• Develop and implement standard operating procedures for billing, credentialing, payer enrollment, and licensing.
• Collaborate with clinical, administrative, billing, and leadership teams to improve operational efficiency.
• Monitor departmental performance and prepare reports on revenue cycle results, credentialing status, and licensing compliance.
• Identify process improvement opportunities and implement corrective action plans.
• Maintain organized documentation to support audits, payer reviews, and regulatory inquiries.
• Train and support team members on applicable billing, credentialing, licensing, and compliance procedures.

Benefits

• Salary to be determined based on experience and qualifications.
• Remote work may be considered based on qualifications and business needs.

Company Description

MDOfficeManager is an equal opportunity employer. Employment decisions are made in accordance with applicable federal, state, and local employment laws.