Manager, Revenue Cycle Management – Home Infusion

🕒 Maio 12

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Shields Health Solutions

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2011

⚕️ Seguro de Saúde

💊 Farmacêutico

☁️ SaaS

Healthcare Insurance • Pharmaceuticals • SaaS

A Shields Health Solutions é uma empresa especializada em fornecer soluções integradas de farmácia especializada. Eles se concentram em eliminar interrupções no cuidado do paciente, oferecendo um modelo abrangente que faz a ponte entre os pacientes e os medicamentos especializados de que necessitam. A Shields Health Solutions faz parcerias com provedores de saúde e fabricantes de medicamentos para otimizar o impacto dos serviços de farmácia especializada. Sua abordagem utiliza um modelo clínico, equipes de cuidado especializadas e uma plataforma tecnológica proprietária para melhorar o acesso dos pacientes a medicamentos especializados, enquanto reduzem o custo total do cuidado. A Shields Health Solutions visa aprimorar as experiências e os resultados de saúde dos pacientes por meio de suas soluções inovadoras na integração de farmácias especializadas.

Descrição

• Manage core home infusion RCM functions, including billing, follow-up, denial management, collections, cash posting, and AR resolution. • Oversee reimbursement workflows for both pharmacy and medical benefit claims, including coordination of infusion drug, nursing, supplies, and ancillary service billing as applicable. • 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 reimbursement leakage. • Lead payor-specific billing and follow-up strategies for commercial, Medicare, Medicaid, managed Medicaid, and other government and contracted payors. • Partner with intake, clinical, and authorization teams to ensure accurate patient onboarding, coverage verification, prior authorization, and financial clearance processes. • Ensure timely identification, escalation, and resolution of billing edits, denials, underpayments, and documentation deficiencies. • Review AR trends and develop action plans to accelerate collections and reduce preventable denials. • Collaborate with client finance teams on cash forecasting, month-end close support, bad debt analysis, and reserve considerations related to revenue cycle performance. • Maintain strong knowledge of home infusion reimbursement rules, including payer policy requirements, Medicare and Medicaid billing considerations, and site-of-care reimbursement dynamics. • Support implementation and optimization of billing systems, workflow automation, reporting tools, and process controls. • Supervise, coach, and develop RCM staff; establish productivity standards and accountability mechanisms across the team. • Serve as a cross-functional partner to contracting, operations, and compliance 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.

🎯 Requisitos

• 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 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. • Strong analytical, problem-solving, and communication skills. • Able to build credibility and communicate effectively with stakeholders at all levels, driving alignment through clear and compelling communication • Ability to manage multiple priorities in a fast-paced, high-growth environment.

🏖️ Benefícios

• California residents employed by or applying for work at Shields have certain privacy rights. • Equal employment opportunities to all employees and applicants for employment.