Company Overview
24 Hour Home Care is an innovative and trusted in-home care company committed to making a positive impact in people’s lives every day. Since 2008, we have delivered high-quality and personalized caregiving services to individuals of all ages and abilities. Today, we provide caregiving services to more than 16,000 clients and employs more than 16,000 caregivers across California. Our commitment to excellence has designated us as one of FORTUNE’s Best Workplaces since 2018, and we continue to strive for excellence in all that we do.
- About the job
Who We Are24 Hour Home Care is a trusted in-home care company committed to making a positive impact in people’s lives every day. For more than 15 years, it has delivered high-quality and personalized caregiving services to people of all ages and individuals with developmental and intellectual disabilities. Today, it provides caregiving services to more than 16,000 clients and employs more than 16,000 caregivers. By putting people first, striving for excellence, and investing in purposeful innovation, 24 Hour Home Care redefines what it means to care. Learn more at www.24hrcares.com.
Who You Are
You are a passionate and performance-driven team player, eager to take on a key role in our company’s growth. You embody Team 24’s Care & Compete Principles and Competencies:
In the spirit of Own(ing) It With Courage, we encourage you to check out our Glassdoor Page to learn more about 24 Hour Home Care and to leave a review about your experience: 24 Hour Home Care: Glassdoor Page
Sound interesting? Read on for more details!
The Role
The RCM Manager, reporting to the Community Supports division’s Finance leader, will oversee RCM responsibilities, including clearinghouse and payor rejections, and manage denials for assigned payors. They will lead a team of RCM associates, analysts, and offshore staff, handling clearinghouse portals, payor enrollment, and related dashboards and reporting. This role involves collaborating with payors, finance, and operations teams to identify process improvements and reduce denied claims. Proficiency in agency billing, Excel, VBA macros, and Power BI are essential. The RCM Manager will also oversee RCM metric reports, manage contract rates and compliance with wage updates, monitor regulations at the Federal, State, County levels, and lead integration projects for new acquisitions.
Responsibilities Include
B/AR: Oversee Analysts/Associates/Supervisor for Revenue Cycle team’s accounts receivable billing, payment allocations, and account reconciliations from payors across the state, as well as payors in multiple states for other acquired businesses. Oversee revenue reporting as part of the month end close process and ensure that month end deadlines are met for reporting purposes. Manage aged receivable balances by aging category, ensure that outstanding balances greater than 1 year are addressed through payor appeals, arbitration, and coordinate with attorneys for potential litigation. Track KPIs for the department and manage team performance relative to goals.
Reporting, Analytics, and Automation: Create and develop ad hoc dashboards in Power BI, including aggregating revenues and hours analyses. Engage India offshore team and lead the development of automation tools in Excel (macros). Develop tools which will automate billing, cash postings, report downloads, reporting, etc.
Denial Management: Manage RCM team members who are responsible for appealing and defending claims denials, adverse audit results, and sanctions from assigned payors. Analyze, track and trend daily, weekly, and monthly denials by payer using denial reporting tools within the clearinghouses. Maintain a system of reporting that provides timely and relevant information on all aspects of denial appeals and billing compliance issues to CS Finance Leader for all payors. Develops and distributes weekly reporting on RCM denial metrics and presents to CS Finance Leader findings and proposed resolutions. Analyzes outstanding accounts receivable and credits and ensures that these are maintained at the levels expected by CS Finance Leader. All with the goal of improving collections and reducing aged AR greater than 90 days, and an overall denial rate of 10%. Formulate and propose process improvement plans and present denial reasons related to billing over authorization, coding errors, and eligibility cross-functionally to operation teams for remediation in the host systems and day-to-day process. Escalate to CS Finance Leader for payor demand letters and potential legal action for aged, denied, claims. If all denial management efforts are exhausted, utilize judgement and experience to identify and execute write off uncollectible claims (e.g., over authorizations, timely filing limits, member eligibility during time of service, unresolvable internal billing errors, etc.). Review write off proposals from individual contributor team members for reasonableness.
Rate Management: Manage payor bill rates and pay rates. In charge of submitting annual minimum wage increase calculations, changes to rate studies implemented by payor sources, following up and securing finalized rate letters with all payors. Responsible for completing and submitting cost worksheets to payors, and overseeing the team in executing these tasks. Responsible to calculate the pay rates to be paid to providers considering the pass-through requirement set by payor sources and municipality minimum wage requirements.
Offshore Management: Manage an offshore team located in India and delegate certain contracts to the offshore team to manage (end to end). Develop performance metrics for the offshore resources, provide feedback on performance, and review and provide feedback to offshore team to ensure quality of the work performed.
Acquisitions and Integrations: Support Deal Team, Finance Team, and Leadership with RCM due diligence for acquired businesses. Lead integration efforts over the RCM process.
Training: Identify industry training courses for team to attend, including RCM conferences, HFMA conferences, etc. Ensure self and team stay informed about current healthcare regulations, including state, county and other municipality related pay requirements, such as mandated pass-throughs and minimum wage etc.
This is a hybrid position, coming into the corporate El Segundo office at least 1x a week.What You Bring To The Table
8+ years of work experience Revenue Cycle Management
5+ years of work experience in Home and Community Based Service Industry or other health care related experience
Knowledge of CPT, HCPCS, and ICD-10 coding principles (required)
Acquisition experience a plus
Experience billing for home care services (i.e., Social Rec, Personal Assistance, FMS)
Strong understanding of revenue recognition standards under U.S. GAAP
Experience working in a multi-location health care organization
Advanced Excel experience – Can independently research and create models using VBA
Strong understanding of Power BI/SQL preferred.
Working knowledge of NetSuite preferred.
Microsoft Access experience preferred.
Requires extensive knowledge of regional center operations and related Medicare and other State regulations
Familiarity with healthcare laws, regulations, and standards, including HIPAA
Proficiency in medical billing software and electronic medical records (EMR) systems, preferably Annkissam or Well Sky
What We Bring To The Table24 Hour Home Care is an Equal Opportunity Employer that is proud of its culture of diversity and inclusion. Individuals seeking employment are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. Additionally, 24 Hour Home Care will consider qualified candidates with criminal histories in a manner consistent with the law.
Qualified applicants with criminal history will be considered for employment in accordance with California Fair Chance Act and the Los Angeles County Fair Chance Ordinance for Employers, ensuring individuals with criminal history have fair and equitable access to opportunities for gainful employment in the unincorporated areas of LA County.
Upon review, should criminal history have a direct, adverse, and negative relationship, 24 Hour Home Care will conduct an Individualized Assessment and provide a Preliminary Notice of Adverse Action; specifying the laws or regulations that impose such restrictions. At which point, 24 Hour Home Care will review the prospective hire’s written response and mitigating circumstances before making a final decision. Should withdrawal of a conditional offer of employment be determined, 24 Hour Home Care will provide a copy of the Second Individualized Assessment.
Individuals have the right to reach out to the LA County Department of Business and Consumer Affairs to file a complaint or if you require additional information.
By Email: info@dcba.lacounty.gov
By Web: https://dcba.lacounty.gov/contact-us/
By Phone: (800) 593-8222
For California applicants: by applying for this position, you acknowledge and consent to the collection, use, and disclosure of your personal information in accordance with our privacy policy and the California Consumer Privacy Act (CCPA).The Expected California Pay Range For This Position
$101,816—$129,812 USD
How to Apply:
APPLY