Revenue Cycle Management Operations Lead

<h2><strong>About Abby Care: Powering the future of care at home for all of America.</strong></h2><p>Abby Care is building the leading AI-native platform for family-led care. America is facing a growing care crisis. Millions more people need care at home than ever. Over 50 million family caregivers support loved ones without the tools, training, or recognition they deserve.<br />We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system.<br />Abby Care combines clinical oversight with an AI-powered platform to train, enable, and support family caregivers in delivering high-quality care at home. Our platform helps health plans and government partners better understand, verify, and improve care in the home. We expand access to care, reduce reliance on higher-cost settings, and help ensure public dollars are spent effectively.<br />We are proud to partner with leading health plans, providers, and community organizations and are backed by top VCs. We envision a future where family-led care is a core part of the healthcare system. Abby Care is building that future.<br /><strong>Join us in solving one of the most important challenges of our time.</strong></p><h2><strong>The Role</strong></h2><p>This role will initially function as a hands-on Revenue Cycle Management (RCM) Lead responsible for establishing billing operations for a newly launched Georgia and New Jersey market. The successful candidate will build processes, conduct payer and regulatory research, create SOPs, and lay the foundation for a scalable RCM department. As the market grows, this role will evolve into a formal people leadership position overseeing billing specialists and offshore team members.</p><h2><strong>Key Responsibilities:</strong></h2><ol><li><p><strong>New Department Development</strong></p><ul><li><p>Lead the establishment of revenue cycle operations for a newly launched market, including researching payer requirements, workflows, billing processes, and reimbursement guidelines.</p></li><li><p>Develop, document, and implement SOPs, workflows, and operational best practices to support future team growth.</p></li><li><p>Research and interpret Georgia and New Jersey Medicaid billing requirements and identify operational requirements necessary to support compliance and reimbursement.</p></li><li><p>Partner with leadership to define team structure, operational processes, performance metrics, and future KPIs as the department scales.</p></li><li><p>Identify process gaps and recommend solutions to improve operational efficiency and future revenue cycle performance.</p></li></ul></li><li><p><strong>Team Leadership:</strong></p><ul><li><p>Initially operate as an individual contributor while building the foundation of the department.</p></li><li><p>Transition into a people leadership role as the Georgia and New Jersey markets expand, including hiring, training, coaching, and managing billing team members.</p></li><li><p>Provide mentorship, onboarding support, and performance coaching to future team members.</p></li><li><p>Experience conducting performance reviews is highly preferred.</p></li></ul></li><li><p><strong>Billing Operations:</strong></p><ul><li><p>Oversee the preparation, submission, and follow-up of insurance claims for home health care services.</p></li><li><p>Ensure accurate coding (CPT, HCPCS, ICD-10) and adherence to payer-specific guidelines.</p></li><li><p>Monitor and resolve claim rejections, denials, and underpayments promptly.</p></li><li><p>Manage accounts receivable to minimize outstanding balances and maximize collections.</p></li></ul></li><li><p><strong>Compliance and Documentation:</strong></p><ul><li><p>Ensure billing practices comply with federal, state, and payer-specific regulations, including Medicare and Medicaid guidelines.</p></li><li><p>Maintain up-to-date knowledge of changes in billing rules and home health care regulations.</p></li><li><p>Review documentation for accuracy and completeness to support submitted claims.</p></li></ul></li><li><p><strong>Process Improvement:</strong></p><ul><li><p>Analyze billing processes and implement strategies to improve efficiency and reduce errors.</p></li><li><p>Collaborate with other departments to address issues impacting the revenue cycle, such as intake and documentation workflows.</p></li></ul></li></ol><h2><strong>The Requirements:</strong></h2><ul><li><p><strong>Education:</strong> High school diploma or equivalent required; Associate’s or Bachelor’s degree in a related field preferred.</p></li><li><p><strong>Experience:</strong></p><ul><li><p>Minimum 3-5 years of experience in medical billing, with at least 1-2 years in a supervisory or leadership role.</p></li><li><p>Proven expertise in home health care billing, including Medicare and Medicaid processes.</p></li><li><p>Experience building, implementing, or improving billing processes and operational workflows is strongly preferred.</p></li><li><p>Georgia and New Jersey Medicaid billing experience is a significant advantage.</p></li><li><p>Candidates with Home Health, Hospice, or Skilled Nursing billing experience will be considered.</p></li><li><p>Intermediate Microsoft Excel proficiency preferred.</p></li></ul></li><li><p><strong>Certifications:</strong> Certified Professional Biller (CPB) or equivalent preferred.</p></li><li><p><strong>Skills:</strong></p><ul><li><p>Excellent organizational, analytical, and problem-solving abilities.</p></li><li><p>Exceptional communication and interpersonal skills to lead a team and collaborate across departments.</p></li><li><p>Strong research and investigative skills with the ability to gather information independently in a newly established market.</p></li><li><p>Demonstrated accountability, including ownership of mistakes, problem resolution, and continuous improvement.</p></li><li><p>Strong conflict resolution, coaching, and delegation skills.</p></li><li><p>Ability to build processes and operate effectively in an ambiguous, startup-like environment.</p></li></ul></li></ul><h2><strong>Benefits:</strong></h2><ul><li><p><strong>Competitive compensation packages</strong> that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus.</p></li><li><p><strong>Comprehensive health coverage that works for you.</strong> Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance.</p></li><li><p><strong>Generous paid time off. </strong>We provide policies that allow you to recharge along with 10 paid company holidays.</p></li><li><p><strong>Financial savings benefits to support your future. </strong>We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered).</p></li><li><p><strong>Paid parental leave to support your growing family.</strong> We provide paid leave, so you can focus on bonding and adjusting to life as your family grows.</p></li></ul><p><em>We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.</em></p><h2><strong>Our Values</strong></h2><ol><li><p><strong>Families First<br></strong>Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, <em>“Would we want this for our own families?”</em></p></li><li><p><strong>Urgency with Precision<br></strong>Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand<strong>.</strong></p></li><li><p><strong>Relentlessly Resourceful<br></strong>As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity.</p></li><li><p><strong>Purpose with Positivity<br></strong>We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve.</p></li><li><p><strong>Driven to Redefine What’s Possible<br></strong>We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care.</p></li></ol>