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Manager, Revenue Cycle Management – Home Infusion

45 minutes ago
Anywhere
Full-time
Senior
Sales Operations
Operations
Apply Now
Shields Health Solutions

Shields Health Solutions

Shields Health Solutions is the first and largest company in the nation to integrate specialty pharmacies within hospitals, focusing on improving patient outcomes and system-wide growth. Their programs and data platforms reduce costs, achieve better cl...

Health Care Providers & Services
1K-5K
Founded 2012
View All Jobs 28

Description

  • Manage core home infusion revenue cycle functions, including billing, follow-up, denial management, collections, cash posting, and accounts receivable resolution.
  • Oversee reimbursement workflows for pharmacy and medical benefit claims, including billing for infusion drugs, nursing, supplies, and ancillary services.
  • Develop and maintain standard operating procedures, training materials, and internal controls to support consistent, compliant execution.
  • Monitor and improve key performance indicators such as DSO, aging, clean claim rate, first-pass yield, denial rate, cash collections, write-offs, and authorization-related leakage.
  • Lead payor-specific billing and follow-up strategies across commercial, Medicare, Medicaid, managed Medicaid, and government or contracted payors.
  • Partner with intake, clinical, and authorization teams to ensure accurate onboarding, coverage verification, prior authorization, and financial clearance.
  • Identify, escalate, and resolve billing edits, denials, underpayments, and documentation deficiencies in a timely manner.
  • Review accounts receivable trends and develop action plans to accelerate collections and reduce preventable denials.
  • Collaborate with finance teams on cash forecasting, month-end close support, bad debt analysis, and reserve considerations.
  • Support implementation and optimization of billing systems, workflow automation, reporting tools, and process controls.
  • Supervise, coach, and develop revenue cycle staff while setting productivity standards and accountability measures.
  • Partner with contracting, operations, and compliance teams on reimbursement issues, audit responses, and process redesign initiatives.
  • Identify opportunities to improve net revenue realization, reduce margin leakage, and enhance the patient and referral source experience.

Requirements

  • Bachelor’s degree required.
  • 5+ years of progressive revenue cycle experience in home infusion, specialty pharmacy, infusion services, or a closely related healthcare setting.
  • 2+ years of people leadership or team management experience preferred.
  • Strong understanding of home infusion reimbursement, including billing under pharmacy and medical benefits.
  • Experience with reimbursement across commercial, Medicare, Medicaid, and managed care payors.
  • Demonstrated success improving accounts receivable performance, denial resolution, and cash collections.
  • Knowledge of prior authorization, benefits investigation, claim adjudication, and payor appeals processes.
  • Experience with infusion billing platforms, pharmacy systems, and reporting and analytics tools.
  • Strong analytical, problem-solving, and communication skills.
  • Ability to build credibility and communicate effectively with stakeholders at all levels in a fast-paced, high-growth environment.
  • Experience in a multi-state home infusion platform, preferred.
  • Knowledge of infusion therapy reimbursement by therapy class and payor type, preferred.
  • Experience partnering with finance on forecasting, close, and revenue analytics, preferred.
  • Background in process improvement, workflow redesign, or automation initiatives, preferred.
  • Familiarity with compliance requirements relevant to home infusion reimbursement and documentation, preferred.

Interested in this position?

Apply directly on the company website

Apply Now

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