Revenue Cycle Management Associate

About the role

Abby Care is revolutionizing in-home care by empowering family caregivers with an AI-driven platform. We are seeking a detail-oriented professional to manage the financial aspects of our home health services, ensuring accurate and timely reimbursement. This role is integral to supporting our mission to expand access to quality care within the comfort of patients' homes. The hire will own the end-to-end financial workflow for our service lines, maintaining the integrity of our revenue cycle. You will be responsible for ensuring that every claim is processed with precision to support sustainable operations. This position requires a proactive mindset to identify and resolve issues before they impact cash flow. You will act as a key liaison between clinical operations and payers to facilitate smooth transactions. Your work will directly contribute to the financial health and scalability of our care delivery model.

Key facts

What you'll do

• Execute the complete claims lifecycle by preparing, submitting, and tracking insurance claims for home health services to optimize reimbursement.
• Conduct thorough verification of billing codes and payer requirements specific to Medicare, Medicaid, and private insurance plans to ensure compliance.
• Perform diligent accounts receivable management by initiating strategic follow-ups on unpaid claims and resolving complex discrepancies efficiently.
• Uphold strict adherence to all relevant healthcare regulations during billing activities to mitigate risk and ensure ethical operations.
• Facilitate clear and effective communication with payers, patients, and internal stakeholders to address billing inquiries and provide timely resolutions.
• Monitor claim status in real-time using specialized tools to identify denials or delays and implement corrective actions promptly.
• Collaborate with clinical teams to gather necessary documentation that supports accurate billing and coding for home health interventions.
• Analyze payment trends and reimbursement data to identify systemic issues and recommend process improvements to the billing workflow.
• Maintain meticulous records of all financial transactions and adjustments to ensure audit readiness and transparency.
• Support the implementation of new billing protocols and technology enhancements to improve accuracy and operational efficiency.
• Serve as the primary point of contact for resolving coding-related questions from payers regarding home health service eligibility.
• Contribute to the ongoing evaluation of payer policies to adapt billing strategies and minimize revenue leakage.
• Provide backup support for related operational tasks as needed to ensure continuity of the revenue cycle during peak periods.
• Promote best practices in revenue management through continuous learning and sharing insights with cross-functional team members.

Requirements

• Possess a High school diploma or equivalent as the minimum educational foundation for this role.
• Demonstrate 1-3 years of professional experience in medical billing, with a preference for candidates with prior work in home health settings.
• Show a clear understanding of standard home health billing codes and the intricacies of insurance reimbursement methodologies.
• Exhibit proven proficiency in navigating electronic health records (EHR) systems and specialized billing software platforms.
• Apply strong attention to detail to ensure error-free documentation and accurate data entry in all financial processes.
• Utilize robust problem-solving abilities to troubleshoot billing issues and find effective solutions independently.
• Maintain strict compliance with healthcare privacy and regulatory standards, including but not limited to HIPAA guidelines.
• Commit to working within the established policies and procedures of the healthcare revenue cycle framework.

Nice to have

• Hold an Associate's or Bachelor's degree in a related field such as healthcare administration or finance.
• Possess Certification in medical billing and coding credentials, such as CPC or CPB, to validate expertise.

Skills & tools

• Leverage experience with Medicare DDE processes and claim clearinghouses to streamline submission and follow-up.
• Demonstrate familiarity with HIPAA regulations and the importance of safeguarding patient information in all interactions.