RCM Operations Team Lead, Provider Transformation

Homeward

13d•$72,000 - $85,000

About The Position

We are seeking a RCM Operations Team Lead to join our growing team and support Homeward’s External Provider Transformation efforts. This individual will play a critical role in reviewing, auditing, and analyzing clinical documentation from external provider partners, ensuring accurate and complete coding of conditions. You will work alongside our manager to translate chart insights into feedback that improves documentation quality, supports proper reimbursement, and This is an ideal role for a proactive, detail-oriented coder with deep knowledge of multiple specialties, exceptional judgment, and experience supporting external practices or provider networks.

Requirements

5+ years in medical billing, coding, or revenue cycle management or experience in related fields required.
Strong understanding of insurance coding, billing, and denial management resolution techniques including Medicare, Medicaid and commercial insurance plans
Able to Identify and implement improvements to billing, coding, and payment posting workflows to enhance efficiency.
Knowledge of regulations: Working knowledge of HIPAA regulations and the importance of maintaining patient confidentiality.
Proven capability to work independently, prioritizing workload, and managing tight review timelines.
One or more of the following: Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC), Revenue Cycle Management Specialist (RCMS), Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), Certified Revenue Cycle Representative (CRCR), Certified Revenue Cycle Professional (CRCP), Certified Revenue Cycle Specialist (CRCS), Certified Outpatient Revenue Cycle Manager (CORCM)

Nice To Haves

Experience working with Rural Health Care, Critical Access Hospitals, or small hospitals.
Background working with external provider groups or vendor-contracted practices.
Experience working in any other areas of RCM (patient registration, prior authorization, eligibility and benefits, charge capture, payment posting, insurance & claim follow-up, or patient payments & delinquent accounts.
Experience with CPSI/TruBridge, eClinicalWorks, or Cerner.

Responsibilities

Support the core functions of mid and end revenue cycle. Coding professional and facility charges. CMS-1500 and UB-04 claim generation and submission. A/R claim follow up investigations and denial management resolution for our rural hospital clients.
The opportunity to work with the latest AI technologies to help you complete various RCM functions.
Maintain quality and productivity standards for the core functions ensure optimal operation and A/R for client success.
Ensure timely reimbursement to reduce days in A/R (Accounts Receivable).
Analyze and resolve denied/rejected claims, including, but not limited to, referrals, authorizations, and medical necessity.
Contact insurance representatives to determine denial reasons and follow up on claim status.
Review denial patterns to identify root causes and implement prevention strategies.
Draft and submit appeals to insurance companies (commercial/government) for denied services.
Train and mentor RCM staff, fostering a high-performance, compliant culture.
Ensure accurate, timely claim submissions, high-quality standards, and optimal financial performance.
Run daily, weekly, or monthly productivity and quality metrics for leadership.
Collaborates with management, clinic staff, and RCM teams to ensure proper billing and collection procedures.
Help shape internal workflows and dashboards that scale denial management effectiveness across the Provider Transformation program.
Participate in and lead special projects related to coding, billing, and denial management such as new service line implementation.