National Home Health RCM & Credentialing Manager

DHVAJ; Oregon; Hybrid; USD 90,000 - 130,000; Full time

Job summary

MDOfficeManager is seeking a National Home Health RCM & Credentialing Manager with 3+ years in adult home health care, billing, and licensing operations across the United States. You will oversee revenue cycle, credentialing, and licensing, ensuring compliance and improved reimbursement performance.

The role requires coordinating nationwide credentialing and licensing, handling Medicare/Medicaid billing, and collaborating with clinical/administrative teams.

Qualifications

• Minimum of three years of hands-on experience in adult home health care or home health operations.
• Minimum of three years of experience in home health billing and revenue cycle management.
• Minimum of three years of experience in healthcare credentialing, payer enrollment, and licensing coordination.
• Demonstrated experience managing nationwide healthcare licensing and credentialing requirements across multiple U.S. states.
• Strong knowledge of Medicare, Medicaid, Medicare Advantage, and commercial insurance billing.
• Experience with home health claims processing, denial management, reimbursement, and accounts receivable.
• Working knowledge of provider credentialing, payer enrollment, license applications, and renewal processes.
• Understanding of state-specific healthcare regulations and applicable home health licensing requirements.
• Experience with electronic health records, medical billing platforms, and credentialing or licensing management systems.
• Strong organizational, analytical, communication, and problem-solving skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced healthcare environment.

Responsibilities

• Oversee end-to-end revenue cycle for adult home health services.
• Manage billing operations for Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
• Monitor revenue cycle performance and implement strategies to improve cash flow and reimbursement timelines.
• Analyze billing discrepancies, identify revenue leakage, and implement corrective measures.
• Track key performance indicators, including days in accounts receivable, claim denial rates, collection rates, and clean claim rates.
• Oversee denied, rejected, and underpaid claims and coordinate appeals and corrected claims.
• Review billing documentation to ensure compliance with applicable reimbursement guidelines.
• Coordinate enrollment with Medicare, Medicaid, and commercial insurance payers, as applicable.
• Maintain accurate credentialing records and establish standardized workflows for nationwide operations.
• Coordinate and oversee applicable healthcare licensing and regulatory requirements for operations across the United States.
• Develop and implement standard operating procedures for billing, credentialing, payer enrollment, and licensing.
• Collaborate with clinical, administrative, billing, and leadership teams to improve operational efficiency.
• Monitor departmental performance and prepare reports on revenue cycle results, credentialing status, and licensing compliance.
• Train and support team members on applicable billing, credentialing, licensing, and compliance procedures.

Skills

Home health billing

Revenue cycle management

Credentialing

Payer enrollment

Licensing coordination

Medicare/Medicaid knowledge

EHR systems

Data analysis

Regulatory compliance

Communication skills

Project management

Tools

Microsoft Excel

Healthcare reporting tools

Job description

National Home Health RCM & Credentialing Manager

Company: MDOfficeManager

Location: Clarksville, Indiana

Job Type: Full-Time

Work Schedule: Monday-Friday, 8:00 AM-5:00 PM

Work Arrangement: Remote work may be considered based on qualifications and business needs.

Salary: TBD

Job Summary

MDOfficeManager is seeking an experienced National Home Health RCM & Credentialing Manager with a minimum of three years of hands‑on experience in adult home health care, home health billing, healthcare credentialing, and nationwide licensing operations. The ideal candidate will have a strong understanding of home health revenue cycle management, insurance billing, provider credentialing, payer enrollment, and state‑specific licensing requirements across the United States. This individual will oversee revenue cycle operations, coordinate nationwide credentialing and licensing activities, ensure compliance with applicable regulatory and payer requirements, and implement strategies to improve reimbursement performance and operational efficiency. The successful candidate must have practical experience managing home health billing and coordinating credentialing and licensing requirements across multiple U.S. states.

1. Revenue Cycle Management

• Oversee the complete revenue cycle for adult home health services, including insurance verification, claims submission, payment posting, accounts receivable, collections, and reimbursement.
• Manage billing operations for Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
• Monitor revenue cycle performance and implement strategies to improve cash flow and reimbursement timelines.
• Analyze billing discrepancies, identify revenue leakage, and implement corrective measures.
• Track key performance indicators, including days in accounts receivable, claim denial rates, collection rates, and clean claim rates.

2. Home Health Billing and Denial Management

• Ensure accurate and timely submission of home health claims in accordance with applicable payer requirements.
• Oversee denied, rejected, and underpaid claims and coordinate appeals and corrected claims.
• Review billing documentation to ensure compliance with applicable reimbursement guidelines.
• Collaborate with clinical and administrative teams to resolve documentation issues affecting claims processing.
• Maintain knowledge of Medicare, Medicaid, and commercial insurance billing requirements applicable to home health services.
• Identify trends in claim denials and implement strategies to reduce billing errors and improve reimbursement.

3. Nationwide Credentialing and Payer Enrollment

• Oversee healthcare credentialing and payer enrollment activities for applicable providers and healthcare organizations operating nationwide.
• Manage credentialing applications, recredentialing, enrollment updates, renewals, and supporting documentation.
• Coordinate enrollment with Medicare, Medicaid, and commercial insurance payers, as applicable.
• Track credentialing status, application progress, approval dates, and renewal deadlines.
• Communicate with insurance companies, credentialing organizations, and regulatory agencies to resolve application delays.
• Maintain accurate credentialing records and establish standardized workflows for nationwide operations.

4. Nationwide Licensing and Regulatory Compliance

• Coordinate and oversee applicable healthcare licensing and regulatory requirements for operations across the United States.
• Manage licensing applications, renewals, expirations, and supporting documentation for applicable healthcare professionals and organizations.
• Research and monitor state‑specific licensing requirements relevant to adult home health services and the organization's operating model.
• Maintain a centralized tracking system for licensing status, renewal deadlines, and outstanding regulatory requirements.
• Coordinate with state licensing boards and regulatory agencies as needed.
• Identify potential licensing and compliance gaps and communicate issues to leadership.
• Ensure applicable licensing and enrollment requirements are addressed before operations or services begin in a jurisdiction.

5. Operations and Team Management

• Develop and implement standard operating procedures for billing, credentialing, payer enrollment, and licensing.
• Collaborate with clinical, administrative, billing, and leadership teams to improve operational efficiency.
• Monitor departmental performance and prepare reports on revenue cycle results, credentialing status, and licensing compliance.
• Identify process improvement opportunities and implement corrective action plans.
• Maintain organized documentation to support audits, payer reviews, and regulatory inquiries.
• Train and support team members on applicable billing, credentialing, licensing, and compliance procedures.

Required Qualifications

• Minimum of three years of hands‑on experience in adult home health care or home health operations.
• Minimum of three years of experience in home health billing and revenue cycle management.
• Minimum of three years of experience in healthcare credentialing, payer enrollment, and licensing coordination.
• Demonstrated experience managing or coordinating nationwide healthcare licensing and credentialing requirements across multiple U.S. states.
• Strong knowledge of Medicare, Medicaid, Medicare Advantage, and commercial insurance billing.
• Experience with home health claims processing, denial management, reimbursement, and accounts receivable.
• Working knowledge of provider credentialing, payer enrollment, license applications, and renewal processes.
• Understanding of state‑specific healthcare regulations and applicable home health licensing requirements.
• Experience with electronic health records, medical billing platforms, and credentialing or licensing management systems.
• Strong organizational, analytical, communication, and problem‑solving skills.
• Ability to manage multiple priorities and meet deadlines in a fast‑paced healthcare environment.

Preferred Qualifications

• Experience supporting adult home health agencies with operations in multiple states.
• Experience managing nationwide licensing and credentialing databases.
• Familiarity with Medicare enrollment systems and commercial payer credentialing portals.
• Previous experience supervising billing, credentialing, or revenue cycle teams.
• Proficiency in Microsoft Excel and healthcare reporting tools.
• Demonstrated success in improving billing accuracy, reducing claim denials, and streamlining administrative processes.

Work Schedule and Location

• Employment Type: Full-Time
• Schedule: Monday-Friday, 8:00 AM-5:00 PM
• Location: Clarksville, Indiana
• Remote Work: May be considered based on qualifications and business needs.
• Compensation: Salary to be determined based on experience and qualifications.

Equal Employment Opportunity

MDOfficeManager is an equal opportunity employer. Employment decisions are made in accordance with applicable federal, state, and local employment laws.