Revenue Cycle Management Operations Lead

About the role

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.

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.

Requirements

• 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.
• 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

Benefits

Additional Information

About Abby Care: Powering the future of care at home for all of America. Abby Care is building the leading AI-native platform for family-led care. America is facing a growing care crisis. Millions more people need care at home than ever. Over 50 million family caregivers support loved ones without the tools, training, or recognition they deserve. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system. Abby Care combines clinical oversight with an AI-powered platform to train, enable, and support family caregivers in delivering high-quality care at home. Our platform helps health plans and government partners better understand, verify, and improve care in the home. We expand access to care, reduce reliance on higher-cost settings, and help ensure public dollars are spent effectively. We are proud to partner with leading health plans, providers, and community organizations and are backed by top VCs. We envision a future where family-led care is a core part of the healthcare system. Abby Care is building that future. Join us in solving one of the most important challenges of our time.

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