Manager, Revenue Cycle Management – Home Infusion

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Shields Health Solutions

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2011

⚕️ Krankenversicherung

💊 Pharmazie

☁️ SaaS

Healthcare Insurance • Pharmaceuticals • SaaS

Shields Health Solutions ist ein Unternehmen, das sich auf die Bereitstellung integrierter Spezialpharmazie-Lösungen spezialisiert hat. Sie konzentrieren sich darauf, Unterbrechungen in der Patientenversorgung zu vermeiden, indem sie ein umfassendes Modell anbieten, das die Lücke zwischen Patienten und den benötigten Spezialmedikamenten schließt. Shields Health Solutions arbeitet mit Gesundheitsdienstleistern und Arzneimittelherstellern zusammen, um die Wirkung von Spezialpharmazie-Dienstleistungen zu optimieren. Ihr Ansatz nutzt ein klinisches Modell, Expertenteams und eine proprietäre Technologieplattform, um den Zugang der Patienten zu Spezialmedikamenten zu verbessern und gleichzeitig die Gesamtkosten der Versorgung zu senken. Shields Health Solutions zielt darauf ab, durch ihre innovativen Lösungen zur Integration der Spezialpharmazie die Patientenerfahrungen und Gesundheitsergebnisse zu verbessern.

Beschreibung

• 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.

🎯 Anforderungen

• 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.

🏖️ Vorteile

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