Billing Revenue Cycle Manager
HR HealthCare
Summary
The Billing & Revenue Cycle Manager will lead and develop the Billing Specialist team and oversee the billing cycle, from intake and eligibility through payment posting, denials, and audits. The Billing & Revenue Cycle Manager shows initiative to step in, assess the billing process, and start improving results.
Job description
Overview of Position
The Billing & Revenue Cycle Manager will lead and develop the Billing Specialist team and oversee the billing cycle, from intake and eligibility through payment posting, denials, and audits. The Billing & Revenue Cycle Manager shows initiative to step in, assess the billing process, and start improving results.
Essential Functions
- Lead, train, and set work priorities for the Billing Specialist team, including productivity and accuracy standards.
- Own front-end accuracy: eligibility and benefits verification in Brightree, communicating coverage, deductibles, and coinsurance to Customer Service and leadership.
- Make sure claims are supported before they go out: correct HCPCS codes and modifiers, diagnosis support, span dates, and documentation such as SWOs, proof of delivery, and CMNs where required.
- Manage ERA/EOB payment posting to keep secondary billing and patient statements flowing.
- Drive denial management and appeals, identifying root causes and fixing them upstream rather than just reworking claims.
- Work directly with payers to resolve underpayments, quantity limits, diagnosis issues, and filing errors.
- Determine prior authorization requirements and build the processes to meet them.
- Partner with our 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 (TPE, RAC, UPIC, CERT, and payer post-payment reviews).
- Report on key revenue cycle metrics, including A/R aging, DSO, denial rate, clean claim rate, and cash collections, to the Director of Operations.
Requirements
- 5+ years of billing/RCM experience in DME, HME, or another post-acute setting (home health, hospice, infusion, O&P).
- 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.
- Hands-on Brightree experience strongly preferred.
- Proven audit-response and appeals experience.
- Strong Excel and reporting skills, and comfort using data to manage a team.
- CRCR, CPC, or similar certification is a plus but not required.
- Strong attention to detail.
- Collaborative.
- Strong written communication skills.
Company overview
HR HealthCare is a professionally managed, family-owned medical device company headquartered in York, Pennsylvania, specializing in the development, manufacture, and supply of healthcare products with integrated technology and support services. The company operates a 100,000 square foot state-of-the-art cGMP compliant, ISO and MDSAP certified manufacturing facility in York, PA, offering comprehensive contract manufacturing capabilities for liquids, gels, lotions, creams, and ointments. HR HealthCare's product portfolio spans multiple healthcare segments including general medical lubricants, urological solutions, wound care products, and ultrasound gels. Key brands include HR® Lubricating Jelly, Surgilube® Sterile Surgical Lubricant, EcoVue® Ultrasound Gel, TruCath® Intermittent and Indwelling Catheters, and Renovar™ Advanced Skin and Wound Solution. The company serves both healthcare professionals and patients through its integrated technology platforms and patient support services, with a mission focused on positively impacting people's lives throughout the care continuum.