Manager, Pre-Billing Revenue Cycle Operations, Home Health

Description

The Manager, Pre-Billing Revenue Cycle Operations, is responsible for overseeing pre-billing and intake-related revenue cycle functions within a home health organization. This role ensures accurate patient intake, insurance verification, and related problem resolution to support timely reimbursement, regulatory compliance, and optimal cash flow. This position plays a critical role in reducing denials, improving clean claim rates, and ensuring operational excellence in the front-end revenue cycle processes specific to home health services.

MINIMUM QUALIFICATIONS:

1. Exemplifies characteristics of The BAYADA Way: compassion, excellence and reliability.
2. Bachelor’s degree in Healthcare Administration, Business, Nursing, or related field (or equivalent experience).
3. Five (5)+ years of revenue cycle experience, with at least two to three (2–3) years in home health or post-acute care.
4. Demonstrated experience in front-end revenue cycle functions
5. Strong knowledge of Medicare home health requirements and Patient-Driven Groupings Model (PDGM).
6. Proven leadership and team management experience.
7. Experience with home health Electronic Medical Record (EMR) platforms – e.g., Homecare Homebase (HCHB)
8. Advanced Microsoft Office and data analysis skills.
9. Strong written and verbal communication skills, attention to detail, and comfort interacting with all levels of management
10. Ability to read, write and effectively communicate in English.

PRIMARY RESPONSIBILITIES:

1. Demonstrate and communicate the core values of BAYADA and The BAYADA Way.

Intake & Patient Access Oversight

1. Ensure complete and accurate insurance verification before start of care (SOC)
2. Evaluate referrals for financial and reimbursement risk, including high-risk non-Medicare cases and high out-of[1]pocket (OOP) exposure.
3. Partner with clinical and sales teams to ensure appropriateness of admissions and financial viability.
4. Develop and implement front-end gatekeeping processes to avoid high-risk admissions where reimbursement is unlikely.
5. Develop or update training materials, guides, and reference documents to support team effectiveness.

Billing Readiness & Revenue Cycle Time Optimization

1. Drive reduction in charge lag/days to bill.
2. Support Notice of Admission (NOA) timeliness to prevent penalties and lost revenue.

Revenue Integrity & Risk Mitigation

1. Monitor and mitigate risk of non-payment, with emphasis on intake-related drivers.
2. Provide write-off and adjustment oversight, including root cause analysis.
3. Partner with billing and collections teams to resolve systemic front-end issues impacting reimbursement.
4. Analyze trends in front-end errors contributing to denials or delayed billing.

Data Analytics and Reporting

1. Develop, track, and report on key performance indicators, including:

• Non-payment risk trends
• Authorization turnaround times
• Eligibility accuracy
• Charge lag and days-to-bill
• Front-end driven denial rates

1. Perform data analysis to identify trends and improvement opportunities
2. Analyze trends in front-end errors contributing to denials or delayed billing.
3. Implement process improvements based on data insights.
4. Demonstrate solid performance or exceed performance standards in key job dimensions/attributes as defined on the Performance Appraisal for Office Staff
5. Perform related duties, or as required or requested by supervisor

BAYADA believes that our employees are our greatest asset:

• Base Salary: $ 72,000-85,000 / year depending on qualifications
• Quarterly Bonus Opportunity
• BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit and employee assistance program
• To learn more about BAYADA Benefits, click here