Company Summary

Hometown Healthcare is a Respiratory Home Medical Equipment & care management company whose purpose is to alleviate the burdens of healthcare. Founded as Watervliet Pharmacy in 1953, Hometown Healthcare has transitioned serving the respiratory needs of patients and their loved ones in the home. Now headquartered in Clifton Park, Hometown Healthcare has evolved over time by adding high-touch and high-tech respiratory products and services, a comprehensive sleep therapy program (for CPAP and Bi-Level patients), non-invasive ventilation, and other home medical equipment. Hometown Healthcare serves a 70-mile radius from the headquarters in New York’s greater Capital Region.

Position Summary

Reporting to the Director of COPD Programs, the Payer Lifecycle Manager (Revenue Cycle Manager) will lead the Lean Conversion of, and the execution of the payer lifecycle for the COPD business unit. Payer lifecycle begins with inbound order triage/prioritization, oversees all on-time, accurate and compliant invoicing and ends with on-time delivery of billing transitions, and records, with all appropriate parties.

How You’ll Make an Impact

• Operate as a subject matter expert in payer medical policy standards, insurance coverage and regulatory guidelines
• Lead the Payer Lifecycle Team and work seamlessly with the Manager of COPD Programs, their team, and the Provider Relationship Manager(s)
• Lead the team to understand referrals’ clinical documentation and ensure adherence to the processing requirements established by the insurance company
• Lead an amazing provider experience from inbound calls/communication through responsive follow-up and closeout
• Responsible for confirming initial, and ongoing, medical necessity ensuring sales order compliance with payer guidelines
• Own the execution of an error free Order Processing Lifecycle (audit sales orders for accuracy, ensure medical necessity, proper insurance verification and authorization, ensure all paperwork is completed with signature and date) and confirm post-delivery sales orders
• Develop and improve business-to-business relationships with payer organizations
• Effectively work cross functionally with the Sleep Order Processing Team, in pursuit of Hometown Healthcare’s vision, values & business goals
• Expected to lead the creation and/or continuous improvement of Standard Work within area of cognizance

What You Must Bring to This Role

• Bachelor’s degree in Healthcare Administration, Business or similar from an accredited program - required
• Master degree or certification in any discipline of business or equivalent experience - desired
• Demonstrated ability to develop, lead and coach the standard work and daily management required to win in a regulated, Quality Management System (QMS) based, Lean inspired healthcare organization - required
• A history of success leading functionally, and cross-functionally within a healthcare organization - required
• Excellent interpersonal strength, with demonstrated ability to build personal and team relationships across the business - required
• History of customer focus and a demonstrated balance of empathy and business acumen - required
• Demonstrated understanding of healthcare insurance approvals, billing and reimbursement lifecycles - desired
• A working knowledge of Brightree, AirView and/or U-Sleep (or similar) - desired
• A member of a professional organization, such as AARC (American Association of Respiratory Care) - desired

Values

• Serve to WOW!
  • Creating experiences that cause those we serve to become Hometown Healthcare evangelists
• Empathy & Grace
  • The glue that bonds and preserves a beneficial and long-standing relationship that is comprised of two ideas:
  • Empathy (cognitive): A decision to pause your thoughts and feelings long enough to engage with the thoughts and feelings of another person
  • Grace: Favor (patience, kindness, goodness, gentleness, self-control, etc.) demonstrated to someone especially when they don't deserve it.
• Teachable Spirit for the Pursuit of Better
  • "It got me to where I am, but won't get me to where I need to go, so therefore I must learn and grow"
• Warrior's Heart
  • Working hard AND producing the results required in spite of the circumstances

Compensation, Benefits & Fun Stuff

• Be a part of a locally owned & operated business, who values treating everyone with integrity & respect
• Be a part of a progressive company challenging the status quo
• Company sponsored benefits program, including retirement plan
• Generous paid time off and paid holidays

Working Conditions & Physical Efforts

• Work is performed in an office work environment
• May be required to lift up to 30 lbs.
• Ability to sit for a prolonged period of time
• Visual functions being those of near vision, depth perception, and ability to adjust focus
• Talking and hearing occur continuously in the process of communicating with the team & client businesses
• Transportation to & from work locations
• Finger dexterity is needed to access, enter, and retrieve data using a computer keyboard or operate equipment
• No or very limited exposure to physical risk

This role is posted in partnership with HR Resolved, Inc.