Manager, Revenue Cycle Management – Home Infusion

🕒 May 12

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Shields Health Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2011

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

Healthcare Insurance • Pharmaceuticals • SaaS

Shields Health Solutions is a company that specializes in providing integrated specialty pharmacy solutions. They focus on eliminating disruptions in patient care by offering a comprehensive model that bridges the gap between patients and the specialty medications they need. Shields Health Solutions partners with healthcare providers and drug manufacturers to optimize the impact of specialty pharmacy services. Their approach leverages a clinical model, expert care teams, and a proprietary technology platform to improve patient access to specialty drugs, while reducing the overall cost of care. Shields Health Solutions aims to enhance patient experiences and health outcomes through their innovative solutions in specialty pharmacy integration.

📋 Description

• 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.

🎯 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 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.

🏖️ Benefits

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