Infusion Solutions is seeking an experienced and strategic Director of Revenue Cycle to oversee all aspects of the revenue cycle for our growing home infusion organization. This leader will be responsible for maximizing revenue capture, improving cash flow, ensuring regulatory compliance, and driving operational excellence across the revenue cycle. The Director will collaborate closely with Billing, Intake, Authorization, Pharmacy, Nursing, and Executive Leadership to optimize processes and enhance the patient financial experience.
Position Summary
Manages all aspects of the organization’s billing and revenue cycle to maximize cash flow while maintaining and improving internal and external relations. Revenue cycle: from intake and insurance verification, revenue recognition, billing, collections, and cash application. Ensure timely, accurate submission and collection of all patients and customer accounts. Responsible for hiring, training, and managing a team of Intake Coordinators and Reimbursement Specialists.
Essential Job Functions
- Revenue Cycle Management: Oversee all aspects of the revenue cycle, including patient registration, insurance verification, charge capture, billing, collections, and denial management.
- Process Optimization: Identify opportunities for process improvement and implement best practices to enhance efficiency and accuracy in revenue cycle operations.
- Compliance: Ensure adherence to all regulatory requirements and payer guidelines, maintaining up-to-date knowledge of billing codes, regulations, and industry standards.
- Team Leadership: Manage and mentor a team of revenue cycle specialists, fostering a culture of continuous improvement and professional development.
- Financial Reporting: Prepare and present financial reports and key performance indicators (KPIs) to senior management, identifying trends and areas for improvement.
- Collaboration: Work closely with clinical teams, finance, and external partners to address revenue-related issues and ensure seamless operations.
- Patient Experience: Focus on enhancing the patient experience by streamlining processes and addressing billing inquiries in a timely and courteous manner.
Duties, responsibilities, and activities may change at any time with or without notice to meet organizational needs.
Supervisory Responsibilities
The Director of Revenue Cycle supervises all staff within the Revenue Cycle department, including billing specialists, patient financial coordinators, and claims analysts. This role is responsible for providing guidance, mentorship, and performance management to ensure the department meets company goals and compliance standards. The Director reports directly to the President/CEO, providing updates on department performance, financial metrics, and operational challenges.
Required Education, Licensure & Experience
All requirements below are job-related and consistent with business necessity.
- Bachelors’ Degree preferred or 5 years insurance experience working with Medicare, Medicaid and third-party insurance.
- Minimum 2 years in a revenue cycle leadership role.
- Ability to communicate effectively in English, both verbally and in writing.
- Excellent written and verbal communication skills.
- Exceptional customer service skills.
- Ability to apply common sense and understanding to carry out instruction furnished in written, oral and diagram form.
- Ability to deal with problems involving several variables in particular situations.
- Professional demeanor to interact with clients, insurance companies and referral sources.
- Computer proficiency, medical terminology and knowledge of Medicare, Medicaid and third-party payer guidelines.
Preferred Education & Experience
Preferred qualifications are not required but are job-related and consistent with business necessity.
- A Bachelor’s or Master’s degree in Business, Finance, Healthcare Administration, or a related field is preferred.
- Home infusion experience preferred.
- Additional languages preferred.
Core Competencies
- Ensures Insurance verification and authorization is complete and processed in a timely manner. Ensures ongoing authorization for services is obtained in a proactive manner and patient demographics and insurance information is entered accurately into computer system.
- Ensure all payers are set up correctly within the software system.
- Ensure staff are updating the fee schedules as soon as those schedules are published.
- Speaks knowledgeably regarding reimbursement issues.
- Evaluates payments received for final resolution and application to patients.
- Ensures timely, accurate submission and collection of claims.
- Follows policies and procedures to obtain approval/denial from President or designee regarding acceptance of client for services.
- Timely and accurate follow-up activity is performed on all invoices that are not paid within 30 days of submission.
- Distributes denials and requests for information to the applicable reimbursement specialist. Ensures these are worked on a daily basis and clear concise AR notes are documented.
- Interface with Caretend to resolve problems as it pertains to the revenue cycle process.
- Trains, monitors and mentors staff.
- Meets cash and DSO goals (<45) monthly and annually.
- Meets AR goal of balances >90 days <= 20%
- Meets AR goal of balances > 180 <= 5%
- Keeps unbilled < 2% of net revenue and bad debt <= 1%.
- Demonstrates professional demeanor when interacting with clients, insurance companies, referral sources and Infusion Solutions staff.
- Ability to negotiate rates.
- Has oversight of cash application process from co-payments and private pay/cash clients into Business Operating System.
- Prepare select reports regarding month end, outstanding AR, cash applications as requested.
- Tracks employee schedules: approving time-off requests in compliance with company standards to ensure that the billing and intake department is staffed appropriately during all business hours.
- Recommend and implement new processes, policies and procedures to maximize revenue, streamline operations and minimize AR.
- Speaks knowledgeably about the scope of services that Infusion Solutions can provide.
- Participates in management meetings and PI program.
- Establishes and maintains Standard Operating Procedures for the Revenue Cycle Department.
- Establish productivity measures for billing and collections staff.
- Establish productivity measures for intake staff.
- Oversees outsourced revenue cycle operations, including key service providers such as Prochant and Collect Plus.
Professional Requirements: Completes annual education requirements.
- Maintains regulatory requirements.
- Maintains client confidentiality at all times.
- Reports to work on time and as scheduled, completes work within designated time.
- Documents time accurately and timely for payroll.
- Attends annual review and in-services, as appropriate.
- Attend staff meetings, reads and returns all monthly staff meeting minutes.
- Represents the agency in a positive and professional manner.
- Actively participates in performance improvement and continuous quality improvement (CQI) activities.
- Complies with all organizational policies regarding ethical business practices.
- Communicates the mission, ethics and goals of the agency.
Physical Demands
For physical demands of position, including vision, hearing, repetitive motion and environment, see the following description. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care.
Frequent sitting, with occasional standing or walking for meetings or departmental walkthroughs. Routine repetitive hand movements for keyboarding and data entry are required. Occasional lifting of files, documents, or office supplies up to 25 pounds may be necessary. Vision and hearing are routinely required for normal office and communication activities.
Work Environment
Primarily an office setting with frequent use of computers, phones, and office equipment. The role involves routine interaction with staff, patients, and other departments. Occasional visits to clinical or infusion sites may be required. The environment is professional, climate-controlled, and generally free from hazardous conditions.
Additional Eligibility Requirements
- Must pass a pre-employment background check and drug screen per company policy and applicable state law.
- Must maintain required immunizations per accreditation standards and company policy.
- Must provide proof of eligibility to work in the U.S.
- Must comply with company policies, codes of conduct, and required training.
- Must hold required licenses or certifications, if applicable.
- Must be available for required shifts with occasional travel as needed for leadership meetings, training, or operational initiatives.
- Must meet role-specific physical, technical, or experience requirements, if applicable.
Work Location: Remote
