Revenue Cycle Manager at Caring for All Inc – Omaha, Nebraska

Role and Responsibilities:

Position Summary:

The Revenue Cycle Manager (RCM) is responsible for overseeing the full revenue cycle for both Home Care and Home Health service lines, ensuring accurate billing, regulatory compliance, timely reimbursement, and optimized financial performance. This role is responsible for managing all aspects of revenue cycle operations, including intake authorization verification, billing, claims submission, payment posting, denial management, and accounts receivable follow-up.

The Revenue Cycle Manager works closely with Home Health clinical leadership, compliance, Finance and Home Care operations teams to ensure billing accuracy, regulatory compliance, and maximum reimbursement across Medicare, Medicaid, commercial payers, managed care organizations, and private pay clients.

ESSENTIAL RESPONSIBILITIES:

Revenue Cycle Operations

• Oversee end-to-end revenue cycle operations for Home Care and Home Health service lines.
• Ensure accurate and timely billing for Medicare, Medicaid, manager care, VA, and private pay clients.
• Monitor Accounts Receivable, collections, and aging reports to maintain healthy cash flow.
• Monitor key revenue cycle KPIs, including days in Accounts Receivable, net collection rate, clean claim rate, denial rate, revenue per episode or visit.
• Develop systems and processes to reduce billing errors, denials, and delayed payments.

Billing and Claims Management

• Ensure accurate submission of claims for Home Health services, including Medicare, PDGM, Medicaid, and commercial payers.
• Ensure accurate submission of claims for Home Care services, including Medicaid waiver programs, private pay, and long-term care insurance
• Oversee coding and billing for services, including but not limited to skilled nursing, therapy services, Home Health visits, personal care services, and infusion services.

Compliance and Regulatory Oversight

• Ensure compliance with all Medicare, Medicaid, and state regulatory requirements.
• Maintain compliance with timely filing limits and payer billing rules.
• Monitor documentation and billing practices to reduce audit exposure and overpayment risk.
• Work with CFO, COO, and other compliance leadership to address billing audits.

Denial Management and Accounts Receivable Follow-up

• Implement structured processes for denial tracking and resolution.
• Analyze denial trends and develop corrective strategies.
• Manage Accounts Receivable follow-up processes to reduce aging and improve collections.
• Oversee re-billing, appeals, and payer escalation when necessary.

Leadership

• Manage and mentor revenue cycle staff.
• Develop team workflows to improve productivity and billing accuracy.
• Establish clear performance metrics and accountability standards.
• Provide training on payer requirements, documentation standards, and billing updates.

Financial Reporting and Analytics

• Prepare monthly reports on revenue trends, Accounts Receivable aging, collection performance, denial rates, and other metrics that emerge as critical.
• Work with Finance leadership to forecast revenue and identify reimbursement risks.

Process Improvement and Technology

• Optimize use of EMR/EHR and billing platforms, including but not limited to WellSky, Therap, and HCHB.
• Implement process improvements to increase clean claim rates and reduce billing cycle times.
• Support implementation of automation, clearinghouse integrations, and reporting tools.

QUALIFICATIONS:

Required-

• Minimum of 7 years of progressive experience in healthcare billing and revenue cycle management.
• Minimum of 3 years of experience in multi-service line revenue cycle operations.
• Strong understanding of medical terminology, documentation standards, insurance guidelines, and payer requirements.
• Experience supervising and training revenue staff.
• Demonstrated ability to manage end-to-end revenue cycle operations.
• Demonstrated ability to identify revenue leakage and implement corrective actions.
• Associate’s or Bachelor’s degree in Healthcare Administration, Business, Accounting or related field, or equivalent experience.

Preferred-

• Systems experience with WellSky, MatrixCare, HCHB, and clearinghouse platforms such as Waystar, Availity, and Zirmed.
• Understanding of medical law and ethics and audit readiness.

COMPETENCIES:

• Supervisory and management skills.
• Analytical and problem-solving skills.
• Decision-making skills
• Excellent communication skills.
• Demonstrate good decision skills.
• Work independently with little supervision.
• Work effectively as a member of a team.
• Be flexible, adaptable, and able to work effectively in a variety of settings.
• Ability to recommend changes to drive business objectives.
• Ability to assess situations to determine the importance, urgency, and risks and make clear and timely decisions in the best interests of the organization.
• Ability to assess problem situations to identify causes, gather and process relevant information, generate possible solutions, and make recommendations or resolve the problem.
• Displays leadership in change management.