Job Details

Job Description

Job Title: Team Lead - Pharmacy & Infusion
Location: Remote
Contract length: Perm
Schedule: Fulltime, M-F
Pay: $60,000 to $70,0000

Job Overview:
The RCM Team Lead is responsible for the staff's financial results of all of the insurance companies assigned to home infusion/pharmacy customers. In addition, this role is responsible for assisting the Director in creating SOPs for the team to follow and assisting the Director in creating procedures and systems for quality assurance as directed by Medicare, Medicaid, and Private insurance. Assist in creating and revising our standard operating procedures and educate our partners, vendors, and internal teams on those procedures. Responsible for training, monitoring quantity, and quality assurance of work performed by internal team members.

Job Responsibilities:

• Understanding all general rules, guidelines, and methods to get paid from their staff's assigned payers and the ability to back up/fill in for staff when necessary
• Responsible for the financial results of each customer by ensuring the accuracy of their team that results in:
  • Streamlining processes that will Reduce adjustments and write-offs
  • Ensure that the billing methodology for each payer is documented and set up throughout the system to realize maximum reimbursement
  • Propose and implement changes and updates to the configuration in areas such as:
    • Price tables
    • Pharmacy Contacts
    • Insurance Settings
    • Therapy and per diems
    • Modules adoption
    • Additional Services
  • Identifying areas of opportunities to better streamline internal or external processes:
    • By making suggestions for system enhancements
    • Or process improvements to increase efficiency and accuracy
• Prepares and submits reports to the Director as needed, including but not limited to:
  • Quality Assurance Reporting
  • Denial Analyst Reporting
  • Service Level Agreement Reporting
  • Productivity and benchmark results
  • Monthly financial reporting
  • Other key reportings
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals
• Maintains patient confidentiality and functions within the guidelines of HIPAA
• Training new employees on Policies & Procedures
• Learning and documenting the billing methodology for new payer assignments for existing or new RCM accounts
• Other tasks and responsibilities as assigned

Qualifications & Experience:

• High school diploma required
• Minimum of 2 years of home infusion billing or accounts receivable experience required
• Minimum of 2 years of experience working in & maintaining HIPAA standards
• Minimum of 2 years of supervisory experience, preferably in home infusion
• Highly skilled in using computers & Microsoft products (Excel and Word) is required
• Math aptitude
• Strong problem-solving skills focused on resolving complex home infusion claims
• An effective communicator with strong oral, written, and persuasive skills and the capability to deal with people at all levels in the organization and the public in a professional manner
• Exceptional organizational skills with a high level of attention to detail and the ability to multitask
• Self-starter, results-driven, highly motivated, high energy
• Nice to Haves
  • 2-year degree or additional college coursework
  • 5 years of experience in a healthcare reimbursement role
  • Proven track record of working towards and exceeding metrics strongly preferred

The staffing industry has seen an increase in people falsely representing themselves as recruiters to gather personal information from job seekers. For your safety, do not provide sensitive data to anyone you have not spoken with thoroughly, never provide banking information during the application process and always double check the email address of the Recruiter to ensure it's from an official Planet domain (@theplanetgroup.com or @launchcg.com) - and not a domain with an alternative extension like .net, .org or .jobs.

The Planet Group and our companies are equal opportunity employers. It is our practice not to discriminate against any employee or applicant based on any criteria, condition or basis protected by laws or regulations in the locations where we do business. All qualified applicants are encouraged to apply. We celebrate diversity and are committed to providing an environment of mutual respect. We believe that diversity, equity and inclusion enable us to better meet our mission and values while serving our clients across the globe. If you have a disability or handicap and would like us to accommodate you in any reasonable way, please inform your recruiter, or contact us, so that we can discuss the appropriate alternatives available.