JOB TITLE: Director, Revenue Cycle Management (RCM) Operations & Payer Integrity
Dept: Revenue Cycle Management
Schedule: Full time
Status: Exempt, Salaried
Reports to: VP RCM
InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting. We have created an ethical, team oriented, and quality work environment for our employees that cultivates achievement and success.
Job Summary:
The Director of Revenue Cycle Management (RCM) Operations & Payer Integrity is responsible for the strategic leadership, operational performance, and financial integrity of the revenue cycle across all infusion services. This role oversees reimbursement optimization, payer contract compliance, revenue capture, denial prevention and recovery, authorization effectiveness, billing operations, payer audits, and payment integrity initiatives.
The Director serves as a key leader in maximizing net revenue while ensuring compliance with payer, Medicare, Medicaid, and regulatory requirements. The position collaborates closely with Finance, Clinical Operations, Pharmacy Operations, Managed Care Contracting, Compliance, Intake, Authorization, Billing, Collections, and Executive Leadership.
This role is accountable for improving cash flow, reducing denials, ensuring payer adherence to contractual obligations, and developing scalable revenue cycle processes that support organizational growth.
Primary Responsibilities:
- Revenue Cycle Operations Leadership
- Payer Integrity & Revenue Assurance
- Denial Prevention & Management
- Infusion Reimbursement Optimization
- Analytics & Reporting
- Compliance & Regulatory Oversight
- Leadership & Team Development
- Perform other duties as assigned by supervisor.
Required Qualifications:
- Bachelor’s degree preferred or 8+ years progressive healthcare revenue cycle experience, including 5+ years in leadership roles.
- Infusion, specialty pharmacy, home infusion, biologics, or specialty drug reimbursement experience strongly preferred.
- Technical knowledge of commercial payer reimbursement, Medicare Part B, Home Infusion Therapy Benefit, Medicaid, Managed Medicare and Medicaid models, PAP Mfg. Programs and Foundations, AWP and ASP pricing, HCPCS/CPT coding, revenue integrity, authorization processes, denial management, and contract compliance monitoring.
- Knowledge of the following operating platforms preferred: CPR, Caretend, Weinfuse, Advanced MD, Epic, Waystar, WellSky, Change Healthcare, Availity, Zelis/PaySpan.
- Preferred certifications: CRCR, CHFP, CPC, CHC, Six Sigma Green Belt or Black Belt.
Physical Demands:
Required to stand, walk, sit, talk and hear; required to use hands to operate vehicles and office equipment; must be able to occasionally lift and/or move up to 25 lbs; specific vision requirements for this job include: close, distance and peripheral vision, and the ability to adjust focus, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.
InfuCare Rx is an equal opportunity employer. All employment decisions are made without regard to race, color, religion, national origin, military status, marital status, citizenship/immigration status, sex (including pregnancy and relation conditions, sexual orientation, or gender identity), age (40 and older), disability, genetic information (including employer requests for, or purchase use, or disclosure of genetic tests, genetic services, or family medical history), retaliation for filing a charge, reasonably opposing discrimination, or participating in a discrimination lawsuit, investigation, or proceeding. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.