Billing Revenue Cycle Manager

HR HealthCare; Woodstock (GA); On-site; USD 90,000 - 125,000; Full time

Job summary

HR HealthCare in Woodstock, GA seeks a Billing & Revenue Cycle Manager to lead the Billing Specialist team and oversee the full cycle from intake to payment posting. The role emphasizes implementing improvements, denial management, and payer relations.

You will drive front-end accuracy, support claims with proper HCPCS codes, and collaborate with contracting and credentialing on payer issues. Strong leadership and Excel/reporting skills are essential.

Qualifications

• 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 DME MAC Jurisdiction C is a plus.
• Experience with Georgia Medicaid and its managed care plans, plus major commercial payers.
• Hands-on Brightree experience strongly preferred.

Responsibilities

• 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.

Skills

Billing/RCM experience

Leadership

Excel

Data reporting

Audit/appeals

Education

CRCR/CPC or similar certification

Tools

Brightree

Job description

Job Details: Job Location: Woodstock GA - Woodstock, GA 30188, 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.

QUALIFICATIONS: 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 DME MAC Jurisdiction C is a plus.
• Experience with Georgia Medicaid and its managed care plans, plus major commercial payers.

QUALIFICATIONS:

• Hands-on Brightree experience strongly preferred. Experience with a comparable DME billing system is also considered.
• 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.