Revenue Cycle Management Operations Lead

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.

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• 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.

• 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.

• 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.

• 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.

• 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.

• 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.