Revenue Cycle Management Manager

Summary

Join Shields Health Solutions' Revenue Cycle Management team as a highly motivated, self-starting individual seeking a challenging career. You will manage daily RCM activities related to home infusion billing and collections, leading a team of RCM analysts supporting partner health system pharmacies. Responsibilities include establishing RCM KPIs, preparing monthly reports, implementing process efficiencies, supporting new system integrations, and managing staff workloads. The ideal candidate possesses home infusion RCM experience, a strong understanding of pharmacy adjudication software, and excellent communication and leadership skills. This role requires a focus on optimization, staff development, and maintaining HIPAA compliance.

Requirements

• Home infusion RCM experience required
• A thorough understanding of pharmacy adjudication software, billing and collections processes
• Knowledge of infusion medical billing, including J coding, 835 and 837 processing
• Developed and maintain billing and collections processes for denied medical claims
• Provide day to day leadership for the RCM staff with a focus on optimization
• Strong organizational, communication and interpersonal skills are a must. A focus on enhanced staff development is a high priority
• Subject matter expert in all pharmacy and home infusion RCM related matters
• Ability to report results in a clear way to allow levels of leadership
• Experience in dealing with financial audits and balance sheet reconciliations
• Highly motivated, team player, ability to prioritize, strong interpersonal and communication skills; discretion and confidentiality essential as position deals with highly sensitive and private data in a HIPAA compliant environment
• Bachelor’s degree preferred
• 5+ years’ experience
• Strong organizational skills and attention to detail
• Excellent verbal and written communication
• Experience with Microsoft Outlook, Word, Excel, PowerPoint and other project management tools
• Interest in data analysis
• Collaborative, team player
• Ability to multitask in a fast-paced environment

Responsibilities

• Manage day to day RCM activity related to home infusion billing and collection
• Manage a team of pharmacy Revenue Cycle (RCM) analysts that support partner health system pharmacies in revenue cycle activity
• Establishes goals related to RCM Key Performance Indicators, including process and workflows to ensure achievement
• Coordinate the preparation of and perform reviews of monthly RCM reports. Present results to both internal and external stakeholders
• Ability to implement efficiency in the month-end close and reporting process
• Proven skills in strategic thinking and analysis, with the ability to diagnose complex problems and recommend practical solutions
• Support the implementation of new health system pharmacies into the Shields revenue cycle
• Balance department workloads amongst the staff to promote efficiency and provide growth opportunities
• Recruit and train new hires to support continued growth
• Manage operational/financial workflows to ensure billing compliance and maximize collectability
• Draft policies and procedures, as well as communication to leadership and staff