Homeward is rearchitecting the delivery of health and care in partnership with communities everywhere, starting in rural America. Today, 60 million Americans living in rural communities are facing a crisis of access to care. In the U.S. healthcare system, rural Americans experience significantly poorer clinical outcomes. This trend is rapidly accelerating as rural hospitals close and physician shortages increase, exacerbating health disparities. In fact, Americans living in rural communities suffer a mortality rate 23 percent higher than those in urban communities, in part because of the lack of access to quality care.
Our vision is care that enables everyone to achieve their best health. So, we’re creating a new healthcare delivery model that is purpose-built for rural America and directly addresses the issues that have historically limited access and quality. Homeward supports Medicare-eligible beneficiaries by partnering with health plans, providers, and communities to align incentives – taking full financial accountability for clinical outcomes and the total cost of care across rural counties.
As a public benefit corporation and Certified B Corp™, Homeward’s mission and business model are aligned to address the healthcare, economic, and demographic challenges that make it challenging for rural Americans to stay healthy. Our Homeward Navigation™ platform uses advanced analytics to connect members to the right care and local resources that address social determinants of health and improve holistic health outcomes. Since many rural communities lack adequate clinical capacity, Homeward also employs care teams that supplement local practices and reach people who cannot otherwise access care.
Homeward is co-founded by a leadership team that defined and delivered Livongo’s products, and backed most recently by a $50 million series B co-led by Arch Ventures and Human Capital, with participation from General Catalyst for a total of $70 million in funding. With this leadership team and funding, Homeward is committed to bringing high-quality healthcare to rural communities in need.
The Opportunity
We are seeking a RCM Operations Specialist to join our growing team and support Homeward’s External Provider Transformation efforts. This individual will play a critical role in reviewing, auditing, and analyzing clinical documentation from external provider partners, ensuring accurate and complete coding of conditions.
You will work alongside our manager to translate chart insights into feedback that improves documentation quality, supports proper reimbursement, and
This is an ideal role for a proactive, detail-oriented coder with deep knowledge of multiple specialties, exceptional judgment, and experience supporting external practices or provider networks.
What You'll Do
- Revenue Cycle Support
- Support the core functions of mid and end revenue cycle. Coding professional and facility charges. CMS-1500 and UB-04 claim generation and submission. A/R claim follow up investigations and denial management resolution for our rural hospital clients.
- The opportunity to work with the latest AI technologies to help you complete various RCM functions.
- Maintain quality and productivity standards for the core functions ensure optimal operation and A/R for client success.
- Ensure timely reimbursement to reduce days in A/R (Accounts Receivable).
- Denial Investigation & Resolution
- Analyze and resolve denied/rejected claims, including, but not limited to, referrals, authorizations, and medical necessity.
- Contact insurance representatives to determine denial reasons and follow up on claim status.
- Review denial patterns to identify root causes and implement prevention strategies.
- Draft and submit appeals to insurance companies (commercial/government) for denied services.
- Collaboration & Enablement Support
- Collaborates with management, clinic staff, and RCM teams to ensure proper billing and collection procedures.
- Help shape internal workflows and dashboards that scale denial management effectiveness across the Provider Transformation program.
- Special Projects
- Participate in and lead special projects related to coding, billing, and denial management such as new service line implementation.
What You Bring
- 2+ years in medical billing, coding, or revenue cycle management or experience in related fields required.
- Strong understanding of insurance coding, billing, and denial management resolution techniques including Medicare, Medicaid and commercial insurance plans
- Able to Identify and implement improvements to billing, coding, and payment posting workflows to enhance efficiency.
- Knowledge of regulations: Working knowledge of HIPAA regulations and the importance of maintaining patient confidentiality.
- Proven capability to work independently, prioritizing workload, and managing tight review timelines.
- One or more of the following: Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC), Revenue Cycle Management Specialist (RCMS), Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), Certified Revenue Cycle Representative (CRCR), Certified Revenue Cycle Professional (CRCP), Certified Revenue Cycle Specialist (CRCS), Certified Outpatient Revenue Cycle Manager (CORCM)
Bonus Points
- Experience working with Rural Health Care, Critical Access Hospitals, or small hospitals.
- Background working with external provider groups or vendor-contracted practices.
- Experience working in any other areas of RCM (patient registration, prior authorization, eligibility and benefits, charge capture, payment posting, insurance & claim follow-up, or patient payments & delinquent accounts.
- Experience with CPSI/TruBridge, eClinicalWorks, or Cerner.
What Shapes Our Company
- Deep commitment to one another, the people and communities we serve, and to care that enables everyone to achieve their best health
- Compassion and empathy
- Curiosity and an eagerness to listen
- Drive to deliver high-quality experiences, clinical care, and cost-effectiveness
- Strong focus on sustainability and scalability of our services
- Nurturing a diverse workforce with a wide range of backgrounds and points of view
- Taking our mission seriously - but not ourselves too seriously; we have fun as we build
Benefits
- Competitive salary
- Paid Time Off
- 11 company paid holidays & 2 personal holidays
- 100% of employee premiums covered for medical, dental & vision insurance
- Company-sponsored 401k plan
- Ongoing professional development opportunities
At Homeward, a diverse set of backgrounds and experiences enrich our teams and allow us to achieve above and beyond our goals. If you have yet to gain experience in the areas detailed above, we hope you will share your unique background with us in your application and how it can be additive to our teams.
Homeward is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Homeward is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.
