[Hiring] Revenue Cycle Management Operations Lead @Abby Care

Role Description

This 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.

Qualifications

• 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.

Requirements

• 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.
• Paid parental leave to support your growing family.