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Senior Manager, Revenue Cycle Management – Home Infusion

3 weeks, 3 days 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 20

Description

  • Serve as a senior revenue cycle advisor to health system executives, finance leaders, pharmacy leadership, and operational stakeholders on reimbursement performance, risks, and strategic opportunities.
  • Develop and execute the revenue cycle strategy for home infusion services, aligning operations, payer requirements, cash acceleration, and margin protection.
  • Build and maintain relationships with health system executives and senior operators to align on performance expectations, issue resolution, and partnership goals.
  • Lead revenue cycle transformation initiatives, including workflow redesign, automation, analytics, standardization, system optimization, and operating model improvements.
  • Manage core home infusion revenue cycle functions, including billing, follow-up, denial management, collections, cash posting, and AR resolution.
  • Oversee reimbursement workflows for pharmacy and medical benefit claims, including billing for infusion drugs, nursing, supplies, and ancillary services as applicable.
  • Monitor and improve KPIs 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 other contracted payors.
  • Partner with intake, clinical, and authorization teams to ensure accurate onboarding, coverage verification, prior authorization, and financial clearance processes.
  • Ensure timely identification, escalation, and resolution of billing edits, denials, underpayments, and documentation deficiencies.
  • Collaborate with client 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 RCM staff while establishing productivity standards and accountability mechanisms.
  • Partner cross-functionally with contracting, operations, and compliance on reimbursement issues, audit responses, and process redesign initiatives.

Requirements

  • Bachelor’s degree required; MBA preferred.
  • 5+ years of progressive revenue cycle experience in home infusion, specialty pharmacy, infusion services, or a closely related healthcare setting.
  • 2+ years of leadership or team management experience preferred.
  • Demonstrated executive presence with the ability to communicate credibly with C-suite leaders, ELT members, health system executives, finance leadership, and senior operational stakeholders.
  • Strong business and financial acumen, including the ability to connect revenue cycle performance to cash flow, margin, forecasting, reserves, working capital, and profitability.
  • Experience supporting or leading executive business reviews, client governance meetings, steering committees, or senior leadership operating reviews.
  • 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 AR performance, denial resolution, and cash collections.
  • Knowledge of prior authorization, benefits investigation, claim adjudication, and payor appeals processes.
  • Experience working with infusion billing platforms, pharmacy systems, and reporting and analytics tools.
  • Ability to manage multiple priorities 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

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