JOB SUMMARY: This position leads the strategic and operational management of medical claims collections in the RCM department. This role ensures timely and accurate reimbursement from payers and optimizes accounts receivable performance. This role builds and mentors a high-performing team, implements data-drive collection strategies, and collaborates cross-functionally to support the organization's financial health.
ESSENTIAL DUTIES AND RESPONSIBILITIES:• Lead and manage daily operations of claims follow-up, denial management, and appeals to ensure timely and accurate reimbursement.
• Develop and implement strategic initiatives to improve collections, reduce aging accounts receivable and optimize cash flow.
• Analyze payer trends, reimbursement delays, and systemic issues; proactively resolve barriers to payment.
• Generate and interpret reports to assess account collectability and provide recommendations for A/R valuation and write-offs.
• Prepare monthly performance dashboards and trend analyses for executive leadership, offering actionable insights and strategic recommendations.
• Utilize Key Performance Indicators(KPIs) to monitor departmental performance and drive continuous improvement.
• Conduct internal audits to ensure accuracy and compliance; implement corrective actions and process enhancements as needed.
• Collaborate cross-functionally with billing, intake, clinical, and training teams to resolve claim issues and ensure staff are current on payer policies and procedures.
• Establish and maintain strong relationships with major payers to expedite resolution of outstanding claims and improve reimbursement timeliness.
• Oversee year-end audit preparation, including documentation coordination and resolution of auditor inquiries.
• Ensure compliance with payer guidelines, internal policies, and regular standards including CMS and HIPAA.
• Lead, coach, and mentor a team of collectors, fostering a culture of accountability, collaboration, and excellence.
• Partner with HR and executive leadership on hiring, promotions, and workforce planning to support departmental growth and stability.
• Set clear performance expectations, conduct regular reviews, and address performance issues promptly and constructively.
• Promote a results-driven environment, encouraging innovation, ownership and continuous learning.
JOB REQUIREMENTS AND QUALIFICATIONS• Proven leadership of large teams (20+ employees) in a healthcare setting.
• Strong knowledge of payer reimbursement policies, coding, and billing regulations.
Education:
• Bachelor's degree in business, finance, or healthcare administration required; Master's degree preferred.
Experience
• Minimum five (5) years of healthcare revenue cycle management, with home infusion experience preferred.
• Proficiency in Microsoft Office Suite; CPR+ experience preferred.
Skill and Competencies:
• High attention to detail and analytical thinking
• Strong time management and process improvement mindset
• Ability to work independently, collaboratively and deliver to deadlines.
• Team leadership and coaching
• Cross-functional collaboration
• Excellent communication, leadership, and problem-solving skills.
• Understanding medical terminology, medical coding, and the healthcare delivery system.
• Proficiency in Excel/Word Docs
• Adaptable to new systems, processes, and technology
What we offer:- Competitive compensation
- Benefits start on your 1st day of employment
- 401k w 4% match - no waiting or vesting period
- PTO / Floating Holidays / Paid Holidays
- Company paid life insurance, short term disability
- Employee Assistance programs to help with mental health / wellness
- Learning & Development Programs
- Perks... includes discounts on travel, cell phone, clothing and more...
- Generous employee referral program
