Senior Medical Billing

4 days ago

Manila, National Capital Region, Philippines Tbwa ChiatDay Inc Full time
Revenue Cycle Management Specialist (Remote)

Remote

About Abby Care

At Abby Care, our mission is to redefine care for the most vulnerable populations.
We are transforming home health through purpose-built, thoughtful technology and a unique care model.
What makes us the home health provider of the 21st century:
Digital health integrations - We leverage telehealth to give our clinical teams superpowers. We build technology to decrease clinical burnout and improve the measurement of health outcomes.
Clinical excellence - We strive to deliver the best-in class care to our families. Our culture encourages clinical growth and emphasizes quality in all our clinical processes.
Family training and support - We believe that the family is key to a patient's wellbeing and health. Our care model incorporates family support into treatment plans.

The Role

The Revenue Cycle Management (RCM) Specialist will be responsible for managing the end-to-end revenue cycle process, ensuring accurate, timely, and compliant billing and collection activities. You will play a key role in optimizing revenue cycles and supporting healthcare providers in maximizing reimbursement, minimizing denials, and reducing inefficiencies within the billing process.

Key Responsibilities:

  • Revenue Cycle Operations: Manage and oversee the full revenue cycle process, including patient intake, insurance verification, coding, billing, collections, and payment posting.
  • Billing & Coding: Ensure accurate coding of diagnoses, procedures, and services in compliance with CMS, payer, and HIPAA regulations. Collaborate with clinical teams to resolve any discrepancies.
  • Claim Management: Submit insurance claims, track claim status, and follow up on unpaid or denied claims. Identify and resolve billing errors to minimize payment delays.
  • Denial Management: Analyze denied claims, investigate root causes, and work with insurance companies to resolve issues and appeal denials. Develop strategies for reducing future denials.
  • Payment Posting & Reconciliation: Post insurance payments and patient payments to accounts. Reconcile payments and identify discrepancies, ensuring accurate account balances.
  • Patient Interaction: Serve as a point of contact for patients regarding billing inquiries, payment plans, and insurance-related questions.
  • Reporting & Analytics: Generate revenue cycle performance reports, identify trends, and provide actionable insights to leadership to improve cash flow, payment collection, and operational efficiency.
  • Compliance & Documentation: Ensure compliance with all healthcare regulations and payer requirements, including HIPAA, coding standards (ICD-10, CPT), and payer policies.
  • Collaboration: Work closely with other departments such as Clinical, Operations, and Finance to streamline processes and ensure smooth coordination in all aspects of the revenue cycle.
  • Continuous Improvement: Participate in process improvement initiatives to enhance revenue cycle management processes, reduce administrative costs, and improve overall financial performance.

Qualifications:

  • Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field (preferred).
  • Certification in Revenue Cycle Management (e.g., CPC, CCS, or AAPC certifications) is a plus.
  • Minimum 2-3 years of experience in revenue cycle management, healthcare billing, or medical coding.
  • Strong knowledge of billing and coding procedures, medical terminology, payer requirements, and healthcare reimbursement methodologies.
  • Experience with Electronic Health Records (EHR) and Practice Management Systems (PMS) is highly desirable.
  • Familiarity with payer policies, including Medicare, Medicaid, and commercial insurance.
  • Strong problem-solving skills and the ability to handle complex billing issues.
  • Excellent communication and interpersonal skills with a customer-centric approach.
  • Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
  • Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and other relevant software.

Preferred Skills and Experience:

  • Experience in a healthcare technology company or working with health tech solutions.
  • Knowledge of advanced RCM software tools and data analytics platforms.
  • Understanding of healthcare regulations, including HIPAA, HITECH, and ACA.
  • Experience in optimizing revenue cycle processes using automation or AI-driven technologies.
Our Value Prop to You
  • Competitive compensation with sign-on bonus, company equity, and benefits. Our builders are a critical part of our team, and we strive to reflect this through ownership and pay.
  • Environment for growth and learning. You will have the opportunity to drive great impact and gain exposure to all functions of the company. Here, you can flex multiple realms of your operating skillset, strategic mindset, and creativity.
  • Propel innovation in healthcare. We are leading the change in healthcare against traditional players and outdated systems. You'll be able to operate in a fast-paced environment and iterate.
  • An energizing, compassionate team. Our team cares deeply about each other. We strive to elevate and uplift each other in our day-to-day work to do the best for our families. We don't believe in bureaucratic nonsense.
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