Manager, Revenue Cycle Management – Home Infusion

Key Responsibilities

• 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.

Qualifications

• Bachelor’s degree or equivalent experience 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 across teams.