Pivot Home Health

This position is a flexible hybrid role, candidate must be located in Colorado

Job Summary 

The Director Revenue Cycle will oversee all aspects of the revenue cycle process, payer relations, compliance systems, and authorization process. This role ensures all billing activities are performed in accordance with applicable federal, state, and payer-specific guidelines. This position plays a key role in supporting the organization’s financial health and adherence to HIPAA regulations. 
 

Essential Duties and Responsibilities 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform these functions. Other duties may be assigned as necessary. 

• Operations Oversight: Manages claim submissions, payment posting, denial management, and accounts receivable.
• Compliance & Policy: Ensures adherence to federal and state healthcare billing regulations and insurance policies. Evaluate and implement systems for auditing.
• Data Analysis: Tracks key performance indicators like denial rates, clean claim rates, and days in accounts receivable.
• Team Leadership: Hires, trains, and supervises billing staff and coordinates with outside vendors.
• Prepare and submit accurate claims to Medicare, Medicaid, commercial insurance, and other third-party payers.
• Build relationships with payers and negotiate and secure contracts.
• Maintain a clear understanding of billing codes, modifiers, and payer requirements to minimize rejections and denials. 
• Monitor claim statuses and follow up promptly on unpaid, denied, or underpaid claims.

Skills, Abilities, and Knowledge Requirements 

• Team leadership experience.
• Minimum of 5 years of healthcare billing experience, preferably in home health or similar healthcare setting. 
• Strong understanding of medical billing processes, including Medicare/Medicaid and commercial insurance.
• Familiarity with claim forms (e.g., CMS-1500), billing codes (ICD-10, CPT/HCPCS), and modifier usage.
• Strong attention to detail with the ability to identify and resolve billing discrepancies.
• Ability to work independently, manage multiple tasks, and meet deadlines in a fast-paced environment. 
• Understanding of healthcare documentation and how it impacts billing and reimbursement.