Senior Manager, Revenue Cycle Management – Home Infusion

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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

• Serve as a senior revenue cycle leader and trusted advisor to health system executives, internal leadership team members, finance leaders, pharmacy leadership, and operational stakeholders on home infusion reimbursement performance, risks, and strategic opportunities. • Develop and execute the revenue cycle strategy for home infusion services, aligning operational performance, payer reimbursement requirements, cash acceleration, margin protection, and scalable growth objective. • Build and maintain strong relationships with health system executives and senior operators to ensure alignment on revenue cycle expectations, performance commitments, issue resolution, and long-term partnership goals. • Lead revenue cycle transformation initiatives across home infusion, including workflow redesign, automation, analytics, standardization, system optimization, and operating model improvements. • 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. • 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.

🎯 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 and confidently with C-suite leaders, ELT members, health system executives, finance leadership, and senior operational stakeholders. • Strong business and financial acumen, including experience connecting 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.

🏖️ Benefits

• California residents employed by or applying for work at Shields have certain privacy rights. • Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.