Billing Revenue Cycle Manager

HR HealthCare•Woodstock, NY

10d

About The Position

The Billing & Revenue Cycle Manager leads and develops the Billing Specialist team and oversees the billing cycle from intake and eligibility through payment posting, denials, and audits. The role calls for initiative in assessing billing processes and improving results. The manager sets team priorities and standards for productivity and accuracy; ensures eligibility, benefits, claim coding, modifiers, diagnoses, dates, and supporting documentation are correct; and oversees payment posting, secondary billing, and patient statements. The role also drives denial resolution and appeals, works directly with payers, establishes prior-authorization processes, and partners with Contracting & Credentialing on payer contracts, fee schedules, and EFT/ERA enrollment. The manager leads responses to Medicare and commercial payer audits and reports key revenue cycle metrics—including A/R aging, DSO, denial rate, clean claim rate, and cash collections—to the Director of Operations.

Requirements

At least 5 years of billing/RCM experience in DME, HME, or another post-acute setting such as home health, hospice, infusion, or O&P.
At least 2 years leading or supervising a billing team.
Strong working knowledge of Medicare DMEPOS rules, including LCDs, documentation requirements, modifiers, capped rentals, and ABNs.
Experience with Georgia Medicaid and its managed care plans, plus major commercial payers.
Proven audit-response and appeals experience.
Strong Excel and reporting skills, and comfort using data to manage a team.
Strong attention to detail.
Collaborative approach.
Strong written communication skills.

Nice To Haves

Experience with DME MAC Jurisdiction C.
Hands-on Brightree experience; experience with a comparable DME billing system is also considered.
CRCR, CPC, or similar certification.

Responsibilities

Lead, train, and set work priorities for the Billing Specialist team, including productivity and accuracy standards.
Ensure accurate eligibility and benefits verification in Brightree and communicate coverage, deductibles, and coinsurance to Customer Service and leadership.
Ensure claims are supported before submission, including correct HCPCS codes and modifiers, diagnosis support, span dates, and required documentation such as SWOs, proof of delivery, and CMNs.
Manage ERA/EOB payment posting to keep secondary billing and patient statements flowing.
Drive denial management and appeals by identifying root causes and correcting issues upstream.
Work directly with payers to resolve underpayments, quantity limits, diagnosis issues, and filing errors.
Determine prior authorization requirements and build processes to meet them.
Partner with the Contracting & Credentialing team on new payer contracts, fee schedules, and EFT/ERA enrollment with Brightree and the clearinghouse.
Lead responses to Medicare and commercial payer audits, including TPE, RAC, UPIC, CERT, and payer post-payment reviews.
Report revenue cycle metrics, including A/R aging, DSO, denial rate, clean claim rate, and cash collections, to the Director of Operations.