HCS Billing Manager / EVV

Position Summary The HCS Billing Manager leads and oversees all billing, claims submission, collections, authorization matching, and revenue cycle management (RCM) operations for our Home and Community Based Services (HCBS) program. This role ensures complete regulatory compliance with the Arizona Health Care Cost Containment System (AHCCCS), Arizona Long Term Care System (ALTCS), Division of Developmental Disabilities (DDD), and contracted Managed Care Organizations (MCOs). The ideal candidate possesses deep expertise in Electronic Visit Verification (EVV) data aggregation, CMS-1500/837 billing, prior authorization reconciliation, and root-cause denial management to protect agency revenue and ensure audit readiness. Core Responsibilities

1. End-to-End Billing & Revenue Cycle Operations

• Manage daily electronic claims processing for all lines of service including: Attendant Care, Respite, Habilitation, Homemaker, Personal Care, Companion Care, and Home Modifications.
• Perform pre-billing audits to ensure 100% verification of service units, rendered dates, HCPCS codes, and modifiers prior to claim transmission.
• Manage payer portal billing submissions across contracted AHCCCS MCOs (e.g., Mercy Care, Banner University Health Plans, United Healthcare Community Plan) and DDD/AHCCCS portals.
• Reconcile weekly and monthly Remittance Advice (RA) statements, posting payments accurately to patient accounts.

2. EVV & Prior Authorization Compliance

• Partner closely with Scheduling and EVV Teams to audit Electronic Visit Verification data (clock-in/clock-out, GPS/IVR, shift sign-offs) against billed visits to prevent non-compliance rejections.
• Perform strict cross-verification between billed claims and active ALTCS/DDD Case Manager Prior Authorizations (PA).
• Identify, resolve, and prevent authorization unit burn-rate overages and unauthorized service delivery.

3. Denial Management, Appeals & Accounts Receivable

• Work closely with the EVV billing team to analyze claim denial trends, unbilled claim backlogs, and aging Accounts Receivable (A/R).
• Lead clean claim initiatives to maintain a target first-pass claim yield above 95%.
• Prepare, file, and track formal claim disputes, reconsiderations, and administrative appeals with MCOs and AHCCCS within state-mandated timelines.

4. Leadership, Analytics & Reporting

• Supervise, mentor, and evaluate the performance of EVV/HCS billing and collections specialists.
• Produce and present monthly executive billing analytics (Gross Billed Hours, Net Revenue, Paid vs. Denied Claims, Days in A/R, Unbilled Hours) directly to executive leadership.
• Conduct ongoing training for billing, authorizations, intake, and scheduling personnel regarding billing code changes, EVV mandates, and authorization procedures.

5. Audit Readiness & Regulatory Compliance

• Lead internal quarterly revenue audits and serve as primary liaison during external financial audits, state compliance reviews, and MCO payer audits.
• Maintain thorough knowledge of the AHCCCS Fee-For-Service Provider Billing Manual, AMPM policies, and state Medicaid updates.
• Ensure strict adherence to HIPAA compliance, patient privacy, and data security standards.

Qualifications and Experience Education: High School Diploma or GED required; Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, Business, or related field strongly preferred.

• Experience:
• Minimum 3–5 years of healthcare billing experience, specifically focused on Arizona AHCCCS, ALTCS, or DDD programs.
• 2+ years in a supervisory or management role overseeing home health or HCBS billing teams.
• Technical Proficiency:
• Hands-on experience with home care software platforms (e.g., HHAeXchange, WellSky, or Sandata).
• Direct experience with EVV aggregators and state clearinghouses.
• Advanced proficiency in Microsoft Excel (VLOOKUPs, Pivot Tables, reporting formulas) and general ledger software.

Knowledge & Skills

• Deep understanding of CMS-1500, 837P/835, HCPCS/CPT codes, HCPCS modifiers, and payer-specific prior authorization rules.
• Comprehensive understanding of AHCCCS MCO contracting, claim dispute resolution, and appeal timelines.
• Strong analytical, problem-solving, and leadership skills.

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Days and hours of work are Monday through Friday, 8:00 am to 5:00pm. Evening and weekend work may be required as job duties demand.

Location: 5025 E. Washington Street, Suite 200, Phoenix, AZ 85034