SUMMARY OVERVIEW

The Revenue Manager specializing in medical billing plays a crucial role in maximizing and safeguarding the financial health of Boston Senior Home Care. This individual is responsible for overseeing all aspects of medical billing operations, ensuring accurate, timely reimbursement of services, compliance with policies and regulations, and the maintenance of transparent financial processes. The Revenue Manager acts as a bridge between clinical/operational teams, administrative departments, external payers, and regulatory bodies, striving to optimize revenue cycle management while upholding the organization’s mission-driven values.

REQUIRED/PREFERRED EDUCATION AND EXPERIENCE

• Education: Bachelor’s degree in finance, accounting, healthcare administration, business, or a related field. Advanced degree or relevant certifications (e.g., Certified Revenue Cycle Representative, Certified Medical Reimbursement Specialist) preferred.
• Experience: Minimum of 3-5 years of progressively responsible experience in medical billing, healthcare revenue cycle management, or related financial roles within a nonprofit or healthcare setting.
• Knowledge: Familiarity with nonprofit financial practices, medical coding, reimbursement methodologies, payer contract terms, and compliance standards.
• Skills: Strong analytical skills, attention to detail, proficiency with billing software and EHRs, and advanced knowledge of Microsoft Excel and reporting tools.
• Leadership: Demonstrated ability to lead, mentor, and develop a diverse team in a mission-driven environment.
• Communication: Excellent written and verbal communication skills with the ability to explain complex billing concepts to both technical and non-technical audiences.
• Problem-Solving: Resourceful and proactive in identifying issues, developing solutions, and driving process improvements.

ADDITIONAL ELIGIBILITY QUALIFICATIONS

• Sensitivity to older adult, disability and diversity issues
• Commitment to maintaining members at home with dignity

ESSENTIAL FUNCTIONS

Duties 1-13 are designated as ADA essential functions and must be performed in this job. All other job duties are secondary functions.

• Revenue Cycle Oversight: Manage the end-to-end revenue cycle, including patient registration, charge capture, coding, claim submission, payment posting, denial management, and account reconciliation.
• Medical Billing Management: Supervise the preparation and submission of medical claims to private insurers, government payers (Medicare/Medicaid), and other sources.
• Compliance: Ensure adherence to federal, state, and local regulations, including HIPAA, Medicare/Medicaid guidelines, and nonprofit standards. Maintain up-to-date knowledge of billing requirements and industry changes.
• Team Leadership: Direct, train, and support medical billing specialists and revenue cycle staff. Promote a collaborative, mission-focused work environment.
• Process Improvement: Analyze billing procedures to identify inefficiencies and opportunities for improvement. Implement best practices to enhance accuracy, reduce denials, and accelerate payment cycles.
• Financial Analysis & Reporting: Work with data analyst to provide financial reports related to billing, collections, accounts receivable, and payer mix. Present findings to directors and senior management.
• Denial Management: Investigate and resolve denied or rejected claims, communicating with payers to appeal decisions and secure reimbursement.
• Grant and Contract Revenue: Oversee billing and revenue processes associated with grants and government contracts.
• Payer Relations: Build and maintain effective relationships with insurance representatives, government agencies, and third-party payers to facilitate timely payments and resolve billing issues.
• Patient Financial Services: Ensure that consumer billing is clear, accurate, and compassionate, supporting equitable access to care regardless of financial situation.
• Technology Utilization: Use billing software, electronic health records (EHR), and other digital tools to streamline operations, ensure data integrity, and monitor performance metrics.
• Audit Preparation: Prepare for internal and external audits by maintaining thorough documentation and records.
• Stakeholder Communication: Serve as a resource to clinical operations and executive staff regarding billing questions, procedures, and revenue policies.

OTHER DUTIES

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• The employee must be able to carry 10 to 15 lbs.
• The employee is regularly required to talk and hear
• The employee is frequently is required to stand, walk, use hands to finger, handle or feel, and reach with hands and arm