Senior Manager, Revenue Cycle Management – Home Infusion

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as a senior leader in revenue cycle management and a reliable advisor to health system executives, internal leadership teams, finance leaders, pharmacy management, and operational stakeholders regarding home infusion reimbursement performance, risks, and strategic opportunities.

• Formulate and implement the revenue cycle strategy for home infusion services, ensuring alignment with operational performance, payer reimbursement criteria, cash flow enhancement, margin protection, and scalable growth objectives.

• Cultivate and sustain strong relationships with health system executives and senior operators to guarantee alignment on revenue cycle expectations, performance commitments, issue resolution, and long-term partnership objectives.

• Direct revenue cycle transformation initiatives for home infusion, including workflow redesign, automation, analytics, standardization, system optimization, and improvements in operating models.

• Oversee essential home infusion RCM functions such as billing, follow-up, denial management, collections, cash posting, and accounts receivable resolution.

• Supervise reimbursement workflows for both pharmacy and medical benefit claims, coordinating the billing for infusion drugs, nursing, supplies, and ancillary services as necessary.

• Track and enhance key performance indicators, including days sales outstanding (DSO), aging, clean claim rate, first-pass yield, denial rate, cash collections, write-offs, and authorization-related reimbursement leakage.

• Develop payer-specific billing and follow-up strategies for commercial, Medicare, Medicaid, managed Medicaid, and other government and contracted payors.

• Collaborate with intake, clinical, and authorization teams to ensure precise patient onboarding, coverage verification, prior authorization, and financial clearance processes.

• Ensure timely identification, escalation, and resolution of billing edits, denials, underpayments, and documentation deficiencies.

• Analyze accounts receivable trends and create action plans to expedite collections and decrease preventable denials.

• Work alongside client finance teams on cash forecasting, month-end close support, bad debt analysis, and reserve considerations related to revenue cycle performance.

• Maintain comprehensive knowledge of home infusion reimbursement regulations, including payer policy requirements, Medicare and Medicaid billing considerations, and site-of-care reimbursement dynamics.

• Aid in the implementation and optimization of billing systems, workflow automation, reporting tools, and process controls.

• Mentor, coach, and develop RCM staff; establish productivity standards and accountability measures across the team.

• Act as a cross-functional partner to contracting, operations, and compliance on reimbursement issues, audit responses, and process redesign initiatives.

⛳️ Requirements

• A Bachelor’s degree is required; an MBA is preferred.

• A minimum of 5 years of progressive revenue cycle experience in home infusion, specialty pharmacy, infusion services, or a closely related healthcare environment.

• At least 2 years of experience in leadership or team management is preferred.

• Proven executive presence with the capability to communicate credibly and confidently with C-suite leaders, ELT members, health system executives, finance leaders, and senior operational stakeholders.

• Strong business and financial acumen, including experience linking revenue cycle performance to cash flow, margin, forecasting, reserves, working capital, and profitability.

• Experience in supporting or leading executive business reviews, client governance meetings, steering committees, or senior leadership operating reviews.

• Comprehensive understanding of home infusion reimbursement, including billing under both pharmacy and medical benefits.

• Experience with reimbursement processes across commercial, Medicare, Medicaid, and managed care payors.

• Demonstrated success in enhancing accounts receivable performance, denial resolution, and cash collections.

• Knowledge of prior authorization, benefits investigation, claim adjudication, and payor appeals processes.

• Familiarity with infusion billing platforms, pharmacy systems, and reporting and analytics tools.

• Ability to juggle multiple priorities in a dynamic, 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.