Remote Revenue Cycle Manager: Infusion & Billing

Optimed Pharmacy Inc; Oshtemo Charter Township (MI); On-site; USD 80,000 - 110,000; Full time

Job summary

OptiMed Health Partners in a remote-capable setting seeks a Revenue Cycle Manager to oversee billing, reimbursement, and care coordination for infusion services. You will audit vendor performance, verify insurance coverage, secure prior authorizations, and manage claims and denials to ensure timely patient access and maximize revenue.

You will collaborate with internal teams and external partners, maintain compliance with payer guidelines and coding standards, and help develop SOPs.

Qualifications

• College degree and/or at least two years’ medical coding, billing and reconciliation experience in the healthcare industry is required; Pharmacy and Infusion preferred.
• Related experience in collections, finance, patient care and communications, or similar qualifications are highly desirable.
• Experience in front end intake functions and processes is beneficial.
• Strong project management and cross-functional team collaboration skills with a demonstrated ability to plan and drive results and achieve deadlines (especially pertaining to diligently working within Timely Filing Constraints) is key.
• Knowledge of EMR systems, healthcare compliance and related legislation is a must.

Responsibilities

• Work with vendors and audit the vendor’s completion of comprehensive benefit investigations to verify patient coverage and eligibility.
• Audit to ensure compliance with payer-specific prior authorization requirements and documents to secure necessary approvals and moving patients to the next step in process
• Review the accurate collection and reconciliation of patient and third-party funds via audit of vendor follow up.
• Help leadership train and provide education via audits for vendors to perform accurate coding of billable services in accordance with current coding standards and payer guidelines.
• Submit claims and monitor their status to ensure timely and accurate reimbursement.
• Resolve claim edits and denials efficiently.
• Aid Vendors in the posting of payments from both payers and patients, ensuring accuracy and compliance with internal controls.
• Maintain a strong working knowledge of EMR systems, healthcare compliance standards, and applicable federal and state regulations.
• Establishing and maintaining relationships with third parties such as vendors and payers.
• Coordinating care with all parties involved.
• Working on any denials or claims requests such as appeals, resubmissions or additional documentation requests.
• Working with leadership to create and keep SOPs up to date and available for vendors to utilize.
• Back up to Front desk/administration assistance, if the candidate is local.

Skills

Medical coding

Billing

Reconciliation

Project management

Cross-functional collaboration

EMR systems

Communication

Confidentiality

Healthcare compliance

Education

College degree

Job description

OptiMed Health Partners in a remote-capable setting seeks a Revenue Cycle Manager to oversee billing, reimbursement, and care coordination for infusion services. You will audit vendor performance, verify insurance coverage, secure prior authorizations, and manage claims and denials to ensure timely patient access and maximize revenue.

You will collaborate with internal teams and external partners, maintain compliance with payer guidelines and coding standards, and help develop SOPs.