Manager, Revenue Cycle Management – Home Infusion

Overview

The Manager, Revenue Cycle Management is responsible for overseeing the daily operations of the home infusion revenue cycle. This includes managing charge capture coordination, billing, collections, cash application, denial management, and accounts receivable optimization. The role requires close collaboration with pharmacy operations, intake, reimbursement, payor contracting, finance, and compliance teams to ensure accurate and timely reimbursement across a diverse range of commercial, Medicare, Medicaid, and managed care payors. The ideal candidate will have extensive home infusion reimbursement expertise, strong operational leadership skills, and a data-driven approach focused on cash flow, margin protection, and process improvement.

Responsibilities

• Manage core home infusion revenue cycle management (RCM) functions such as billing, follow-up, denial management, collections, cash posting, and accounts receivable resolution.
• Oversee reimbursement workflows for pharmacy and medical benefit claims, coordinating billing for infusion drugs, nursing, supplies, and ancillary services as applicable.
• Develop and maintain standard operating procedures, training materials, and internal controls to ensure consistent and compliant execution.
• Monitor and improve 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.
• 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.
• Identify, escalate, and resolve billing edits, denials, underpayments, and documentation deficiencies in a timely manner.
• Analyze accounts receivable trends and develop action plans to accelerate collections and reduce preventable denials.
• Collaborate with finance teams on cash forecasting, month-end close support, bad debt analysis, and reserve considerations related to revenue cycle performance.
• Maintain up-to-date 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.
• 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.
• Minimum of 5 years of progressive revenue cycle experience in home infusion, specialty pharmacy, infusion services, or a closely related healthcare setting.
• At least 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.
• Proven success in improving accounts receivable 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.
• Ability 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.

Preferred Qualifications

• Experience in a multi-state home infusion platform.
• Knowledge of infusion therapy reimbursement by therapy class and payor type.
• Experience partnering with finance on forecasting, close, and revenue analytics.
• Background in process improvement, workflow redesign, or automation initiatives.
• Familiarity with compliance requirements relevant to home infusion reimbursement and documentation.

Location

California residents employed by or applying for work at this organization have certain privacy rights as outlined in applicable workforce privacy notices.

Equal Opportunity

The employer provides equal employment opportunities to all employees and applicants and prohibits discrimination and harassment based on 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.