Revenue Cycle Management Operations Lead | JobSetuu

Description

Job Overview

• Source: Jobicy

Job Description

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.

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.

Key Responsibilities:

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

• Experience:

  • 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.

• Skills:

  • 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. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered).

• Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows.

We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.

Our Values

1. Families First
   Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, “Would we want this for our own families?”

2. Urgency with Precision
   Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand.

3. Relentlessly Resourceful
   As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity.

4. Purpose with Positivity
   We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve.

5. Driven to Redefine What’s Possible
   We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care.

Expert Career Tips for Revenue Cycle Management Operations Lead Roles

To succeed in a competitive market as a Revenue Cycle Management Operations Lead, you need more than just technical skills. Here are some expert strategies to elevate your profile:

• Build a Strong Portfolio: For technical roles, a clean GitHub or a personal project site is essential. For non-technical roles, a case study portfolio demonstrating problem-solving and impact is equally valuable. Show, don't just tell, what you have achieved in your previous positions.
• Master the Narrative: When interviewing, use the STAR method (Situation, Task, Action, Result) to structure your answers. Quantify your results wherever possible—mentioning "increased efficiency by 20%" is much more impactful than saying "improved efficiency."
• Continuous Learning: The industry moves fast. Whether it's staying updated with the latest AI tools or mastering a new management methodology, continuous professional development is key. Consider obtaining industry-recognized certifications that align with Revenue Cycle Management Operations Lead requirements.
• Networking: Connect with other professionals in similar roles. Join online communities, attend webinars, and engage in meaningful discussions on professional social networks. Often, the best opportunities come through referrals and community engagement.
• Soft Skills Matter: Communication, empathy, and leadership are often the deciding factors between two equally qualified technical candidates. Cultivate these skills as they are universally valued across all industries and seniority levels.

Additionally, research the specific company's culture and values. Tailoring your application to show how you align with their mission can significantly increase your chances of moving forward in the process.

Salary & Compensation

Salary not disclosed; typically competitive for the role.

Work Arrangement

Type: On-Site

Standard business hours at the office.

Comprehensive Application Strategy & Hiring Process

Applying for a new role is a marathon, not a sprint. Follow this strategic approach to maximize your success rate:

1. Initial Research & Tailoring

Don't send the same resume to every employer. Spend at least 30 minutes researching the company. Look for recent news, their product roadmap, and their team structure. Modify your summary and core competencies to reflect the specific keywords found in the job description.

2. The Perfect Cover Letter

If the application allows for a cover letter, use it to tell a story that your resume cannot. Explain why you are passionate about this specific company and how your unique background makes you the perfect fit for the challenges they are currently facing.

3. Navigating the Multi-Stage Interview

Most modern hiring processes involve 3-5 stages. This typically includes a recruiter screen, a technical or skill-based assessment, a peer interview, and a final leadership round. Prepare for each stage differently: focus on enthusiasm and fit for the recruiter, technical depth for the assessment, and strategic vision for the leadership round.

4. Post-Interview Follow-Up

Always send a personalized thank-you note within 24 hours of each interview. Reference a specific topic discussed during the call to demonstrate your active listening and genuine interest in the role.

By following these steps, you demonstrate a high level of professionalism and attention to detail that sets you apart from the average applicant.

Typical Interview Process

1. Resume screening
2. HR call
3. Skill interview
4. Final manager interview
5. Offer

Tip: Research the company's products and culture.

Global Market Intelligence & Relocation Insights

At JobSetuu, we specialize in helping talent navigate the global job market. Here is what you need to know about the current landscape in Global and beyond:

The demand for skilled professionals is increasingly borderless. For roles based in Global, understanding the local cost of living, visa requirements (if applicable), and cultural nuances is vital. If this is a remote role, consider the time zone alignment and the asynchronous communication culture of the hiring organization.

Relocation Support: Many forward-thinking companies offer relocation packages that include moving stipends, temporary housing, and legal assistance with work permits. When evaluating an offer, look beyond the base salary—consider the total compensation package, including equity, bonuses, and healthcare benefits.

Work-Life Balance Trends: Hybrid and remote work have become standard in many regions. Research the local labor laws and common practices regarding work hours and vacation time to ensure the role aligns with your lifestyle goals.

Leveraging JobSetuu's tools can help you compare salaries across different cities and understand the "purchasing power" of your potential offer, ensuring you make an informed decision for your long-term career path.

Skills & Competency Roadmap for Professional Development

To remain competitive in Professional Development, we recommend focusing on the following core competencies over the next 12-18 months:

• Technical Mastery: Deepen your expertise in the core tools and languages relevant to your field. For developers, this might be cloud architecture; for marketers, it might be data-driven attribution modeling.
• AI Augmentation: Learn how to leverage generative AI and automation tools to increase your productivity. Understanding how to integrate these technologies into your workflow is becoming a non-negotiable skill.
• Leadership & Strategy: Even in individual contributor roles, the ability to think strategically and lead projects from inception to completion is highly valued. Focus on stakeholder management and high-level project planning.
• Data Literacy: The ability to interpret data and use it to drive decisions is essential across all business functions. Familiarize yourself with data visualization and basic analytical concepts.

By investing in these areas, you not only prepare yourself for the role you are applying for today but also build a resilient foundation for the opportunities of tomorrow.

Apply via JobSetuu

Discover your next career milestone on JobSetuu. This Revenue Cycle Management Operations Lead position is part of our commitment to bringing you the most relevant and high-impact job openings globally. At JobSetuu, we simplify your job search by aggregating premier listings and providing the tools you need to stand out. Don't miss the chance to elevate your professional journey—explore more opportunities and career insights on our platform today.