Revenue Cycle Manager - RE Pharmacy

Position Overview:
Oversees reimbursement within the pharmacy & infusion centers operations departments, providing leadership to the departments while managing processes, productivity, and financial performance for the assigned area. Key responsibilities include intake, billing, collections, cash posting, and benefit verifications. Develops and implements revenue cycle strategies and intake protocols to achieve goals related to new referrals, accounts receivable, bad debt, and cash flow. Ensures financial targets are met and aligned with organizational objectives.

• Directly manages the billing and collections team, overseeing day-to-day operations in the revenue cycle center.
• Reviews new referrals to ensure profitability, verifying patient eligibility and obtaining authorizations based on payor standards.
• Maximizes reimbursement by ensuring timely and accurate claims submission and payment per contracted rates.
• Monitors reimbursement activity, providing trend reports and assessments to senior management.
• Tracks key performance indicators in reimbursement, working with supervisors to improve service levels, cash flow, reduce DSO, and minimize bad debt.
• Ensures compliance with company, Medicare, Medicaid, and payor guidelines, performing audits as needed.
• Anticipates and communicates legislative and regulatory changes impacting billing policies.
• Completes required projects and reports on a daily, weekly, or monthly basis as directed by the COO.
• Audit all billing and collections KPIs to ensure proper accuracy and within expected timelines
• Fosters a positive work environment, building morale, motivation, and teamwork.
• Develops, coaches, and manages staff through training, setting objectives, and performance feedback.

Plus – may perform other duties as assigned.

Education:

• Bachelor’s degree in Business Administration or Health Care informatics preferred.

Experience:

• Bachelor’s degree and at least 4 years of healthcare reimbursement/billing experience OR a high school diploma and at least 7 years of healthcare reimbursement/billing experience
• At least 2 years of experience directly managing people including hiring, developing, motivating, and directing people as they work
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems

Supervision and Management Responsibilities:

• Lead and oversee the corporate billing and reimbursement department, including the management of aging components, billings, cash receipts, and funding services.

Working Conditions:

• Standard office environment.
• Occasional travel within Southern California may be required.
• Full-time position with standard business hours; flexibility to work additional hours during peak periods is expected.

Equal Opportunity Employer:
We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees.