Homeward · 10 hours ago
RCM Operations Team Lead, Provider Transformation
United States
Full-time
Remote
Senior Level
$72K/yr - $85K/yr
5+ years expHomeward is rearchitecting the delivery of health and care in partnership with communities everywhere, starting in rural America. The RCM Operations Team Lead will support Homeward’s External Provider Transformation efforts by reviewing, auditing, and analyzing clinical documentation from external provider partners, ensuring accurate and complete coding of conditions.
Artificial Intelligence (AI)Health CareHospital
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
Qualification
Required
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)
Preferred
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
Benefits
Paid Time Off
11 company paid holidays & 2 personal holidays
100% of employee premiums covered for medical, dental & vision insurance
Company-sponsored 401k plan
Ongoing professional development opportunities
Company
Homeward
Homeward is focused on improving access to high-quality, affordable primary and specialty care in rural communities.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$82MKey Investors
Advanced Research Projects Agency for HealthARCH Venture Partners,Human CapitalGeneral Catalyst
2025-02-12Grant· $12M
2022-08-03Series B· $50M
2022-03-07Series A· $20M
Leadership Team
Alexandre Thome
SVP Product & Technology
Recent News
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