Revenue Cycle Jobs in Riverside, CA (NOW HIRING)

Director of Intake & Patient Access

Position Summary

Oso Home Care is seeking an experienced, strategic, and results-driven Director of Intake & Patient Access to provide executive leadership and operational oversight for all patient access functions across our Home Infusion, Specialty Pharmacy, Home Health, and Ambulatory Infusion Center (AIC) operations. This position is responsible for leading all Intake, Benefits Investigation, Insurance Verification, Prior Authorization, Financial Clearance, Referral Management, and Patient Access activities while ensuring timely, compliant, and financially sound admissions.

The Director serves as a key member of the leadership team and is responsible for developing and executing the strategic vision for the Intake Department while optimizing patient access, referral conversion, operational efficiency, reimbursement performance, and customer satisfaction. This leader partners closely with Executive Leadership, Pharmacy, Nursing, Revenue Cycle, Finance, Information Technology, Sales, Clinical Operations, and Business Development to ensure seamless coordination across departments, improve organizational performance, and support continued company growth.

The Director is accountable for departmental budgeting, workforce planning, technology optimization, vendor management, quality initiatives, operational analytics, regulatory compliance, and the achievement of key organizational performance indicators.

Essential Responsibilities

Executive Leadership & Strategic Planning

• Provide executive leadership and strategic direction for all Intake and Patient Access operations.
• Develop and execute departmental strategic initiatives aligned with the Company's mission, growth objectives, and operational goals.
• Participate as a member of the leadership team in organizational planning, business development, and operational decision-making.
• Develop annual operating plans, departmental budgets, staffing models, and workforce plans.
• Build, mentor, and develop high-performing leaders through coaching, succession planning, leadership development, and performance management.
• Establish department-wide service standards, productivity expectations, accountability measures, and operational benchmarks.
• Lead organizational change initiatives and drive continuous improvement throughout the patient access process.
• Present departmental performance, financial results, and strategic initiatives to Executive Leadership.

Patient Access & Intake Operations

• Provide oversight of the complete patient intake lifecycle from referral receipt through admission.
• Ensure timely, accurate, and compliant processing of all patient referrals.
• Oversee Benefits Investigation, Insurance Verification, Prior Authorization, Financial Clearance, Referral Coordination, and Patient Admissions.
• Ensure accurate documentation of patient demographics, physician orders, insurance information, authorizations, and clinical documentation within the electronic medical record.
• Oversee hospital referral portals, electronic referral platforms, and referral management systems to maximize responsiveness and referral conversion.
• Develop standardized intake workflows across all locations and service lines.
• Monitor referral volume and allocate staffing resources to meet operational demands and service level expectations.
• Ensure seamless coordination between Intake, Pharmacy, Nursing, Scheduling, Billing, Clinical Services, and Revenue Cycle departments.

Financial & Revenue Cycle Leadership

• Partner with Revenue Cycle, Billing, Finance, and Executive Leadership to maximize reimbursement and optimize cash flow.
• Evaluate payer trends, reimbursement performance, denial patterns, authorization outcomes, and referral conversion metrics.
• Develop strategies that improve reimbursement while minimizing denials and payment delays.
• Ensure intake decisions support medical necessity, payer requirements, reimbursement integrity, and revenue cycle performance.
• Oversee financial clearance processes and identify opportunities to improve reimbursement outcomes.
• Monitor payer mix and identify opportunities to improve organizational financial performance.
• Support patient financial assistance through manufacturer copay assistance, foundation grants, and other funding resources when appropriate.

Operational Excellence

• Develop and continuously improve departmental policies, procedures, workflows, and operational standards.
• Utilize Lean process improvement methodologies to eliminate inefficiencies and improve patient access.
• Develop operational dashboards, scorecards, and executive KPI reporting.
• Analyze referral trends, productivity, staffing utilization, turnaround times, payer performance, denial trends, and operational metrics.
• Lead technology implementation projects and workflow automation initiatives that improve operational performance.
• Recommend innovative solutions that enhance efficiency, scalability, and patient experience.

Business Development & Strategic Partnerships

• Partner with Sales and Business Development to improve referral conversion and strengthen referral relationships.
• Develop collaborative relationships with hospitals, physician practices, discharge planners, case managers, and strategic referral partners.
• Identify opportunities to expand referral sources, improve market share, and support organizational growth initiatives.
• Collaborate with Managed Care and Contracting teams regarding payer relationships, reimbursement opportunities, and contract implementation.

Cross-Functional Leadership

• Serve as the executive liaison between Intake, Pharmacy, Nursing, Clinical Services, Scheduling, Revenue Cycle, Finance, Information Technology, Compliance, Human Resources, and Executive Leadership.
• Foster collaboration across departments to improve communication, patient experience, and operational efficiency.
• Support enterprise-wide initiatives that improve quality, operational performance, and patient outcomes.

Vendor & Technology Management

• Oversee outsourced intake, reimbursement, and patient access vendors while ensuring compliance with Business Associate Agreements (BAAs) and contractual service expectations.
• Evaluate vendor performance using measurable KPIs and service level agreements.
• Lead implementation and optimization of EMR systems, referral management software, hospital referral portals, workflow automation, and operational reporting tools.
• Partner with Information Technology to identify technology solutions that improve operational efficiency and patient access.

Financial Management

• Develop and manage departmental operating and capital budgets.
• Monitor labor productivity, staffing ratios, overtime, and operational expenses.
• Evaluate departmental financial performance and implement strategies to improve cost efficiency.
• Support annual budgeting, forecasting, workforce planning, and long-term operational planning.

Compliance & Quality

• Ensure compliance with CMS regulations, HIPAA, ACHC accreditation standards, state and federal regulations, payer requirements, and company policies.
• Lead departmental Quality Assurance and Performance Improvement (QAPI) initiatives.
• Develop corrective action plans to address operational, quality, or compliance deficiencies.
• Ensure department readiness for accreditation surveys, audits, and regulatory inspections.
• Maintain departmental policies, procedures, competency programs, and training materials.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Pharmacy, Finance, or related field required.
• Master's degree (MBA, MHA, MSN, or related discipline) preferred.
• Minimum of 7-10 years of progressive leadership experience in Home Infusion, Specialty Pharmacy, Home Health, Revenue Cycle, or Patient Access operations.
• Minimum of 5 years leading managers, supervisors, or multidisciplinary healthcare teams.
• Demonstrated success leading large operational departments and driving organizational change.
• Extensive knowledge of Home Infusion reimbursement, specialty pharmacy operations, patient access, and healthcare revenue cycle management.
• Strong understanding of Medicare, Medicaid, Managed Care, Commercial Insurance, Workers' Compensation, and government payer requirements.
• Advanced knowledge of Prior Authorization, Benefits Investigation, Insurance Verification, and Financial Clearance processes.
• Thorough understanding of CMS regulations, HIPAA, ACHC accreditation standards, and healthcare compliance.
• Experience with electronic medical records, referral management systems, operational reporting platforms, and business intelligence tools.
• Proven ability to lead organizational growth, improve operational performance, and manage multiple priorities in a fast-paced healthcare environment.

Knowledge, Skills & Abilities

• Executive leadership and organizational development
• Strategic planning and operational execution
• Financial management and budget administration
• Healthcare revenue cycle expertise
• Advanced analytical and problem-solving skills
• Data-driven decision making
• Change management and process improvement
• Executive communication and presentation skills
• Team development and succession planning
• Relationship management and negotiation
• Cross-functional leadership
• Regulatory compliance and accreditation readiness
• Proficiency with Microsoft Office Suite, reporting platforms, and healthcare information systems

Preferred Qualifications

• Master's Degree (MBA, MHA, MSN)
• Lean Six Sigma certification
• Project Management Professional (PMP) certification
• Multi-site healthcare leadership experience
• Home Infusion or Specialty Pharmacy leadership experience
• Experience implementing enterprise technology platforms
• Experience leading accreditation surveys and regulatory audits
• Knowledge of specialty pharmacy reimbursement methodologies and financial assistance programs

Core Competencies

• Executive Leadership
• Strategic Vision
• Operational Excellence
• Financial Acumen
• Business Development
• Revenue Cycle Optimization
• Budget Management
• Organizational Development
• Talent Development
• Change Management
• Regulatory Compliance
• Quality Improvement (QAPI)
• Data Analytics
• Customer Experience
• Cross-Functional Collaboration
• Relationship Management
• Innovation
• Decision Making
• Communication
• Accountability

Key Performance Indicators (KPIs)

• Referral turnaround time
• Referral-to-admission conversion rate
• Time from referral to admission
• Prior authorization turnaround time
• Authorization approval rate
• Insurance verification accuracy
• Financial clearance turnaround time
• Patient access within established service levels
• Revenue capture from referrals
• Payer mix optimization
• Denial rate
• Appeal success rate
• Department productivity
• Productivity per FTE
• Overtime utilization
• Labor cost management
• Customer satisfaction
• Referral source satisfaction
• Employee engagement and retention
• Quality assurance outcomes
• Compliance audit scores
• Accreditation readiness
• Budget performance
• Operational dashboard performance
• Strategic initiative completion