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Position Summary

The Revenue Cycle Manager is a hands-on leader responsible for overseeing the daily operations of Capstone's revenue cycle while actively supporting billing accuracy, denial management, collections, and accounts receivable performance. This role works alongside internal departments and the franchisor's Revenue Cycle Management (RCM) team to ensure claims are processed accurately, reimbursement is maximized, and revenue cycle issues are resolved promptly.

The Revenue Cycle Manager monitors daily workflows, identifies process improvements, assists with complex billing and reimbursement issues, and provides leadership and guidance to the Collections team. Success in this role requires strong operational knowledge, attention to detail, collaboration across departments, and a commitment to supporting the day-to-day functions of the revenue cycle while driving continuous improvement.

Essential Duties and Responsibilities Revenue Cycle Operations

• Oversee the daily revenue cycle process, including billing, denial management, collections, and accounts receivable.
• Monitor key performance indicators (KPIs), including unbilled accounts, accounts receivable aging, denials, and cash collections.
• Identify operational issues affecting reimbursement and implement practical solutions.
• Assist with resolving complex payer issues and reimbursement concerns.
• Recommend and implement workflow improvements that increase efficiency and cash capture.

Billing and Claim Integrity

• Review billing workflows to ensure claims are accurate, complete, and submitted in a timely manner.
• Identify documentation gaps, coding errors, and billing issues that impact reimbursement.
• Partner with Intake, Authorizations, Pharmacy, and Nursing to improve clean-claim performance.
• Promote standardized billing practices and compliance with payer requirements.

Payment Posting and Reconciliation

• Monitor payment posting for accuracy and timeliness.
• Review Electronic Remittance Advices (ERAs), Explanations of Benefits (EOBs), payment variances, and reconciliation reports.
• Work with corporate Revenue Cycle Management staff to resolve posting discrepancies and payment issues.
• Ensure accurate reconciliation of payments, adjustments, and accounts receivable balances.

Denial Management

• Review denial trends and identify root causes.
• Coordinate denial follow-up and appeals for complex claims.

Qualifications

• Five or more years of revenue cycle experience in home infusion, specialty pharmacy, or healthcare billing.
• Strong understanding of payer requirements, prior authorizations, clean-claim submission, and documentation dependencies.
• Experience reviewing ERAs and EOBs, posting discrepancies, denials, and accounts receivable activity.
• High attention to detail and consistency in workflow execution.
• Intermediate proficiency in Microsoft Excel, including sorting, filtering, and lookups.
• Strong communication skills with the ability to work across departments and with the corporate team.

Physical Requirements

• Regular phone communication with payers and team members.
• Ability to hear and speak clearly by telephone for extended periods.
• Ability to sit at a desk or workstation for prolonged periods, potentially up to eight hours per day, while using a computer and telephone system.
• Frequent use of hands and fingers to operate a computer keyboard, mouse, telephone headset, and other standard office equipment.

Work Environment

This position may be performed either onsite at the pharmacy or from an approved home-based workspace, depending on operational needs and the employee's assigned work arrangement.

Employees working from home must maintain a private, secure, professional, and distraction-free workspace that protects patient confidentiality and complies with HIPAA requirements. Reliable internet access and the appropriate use of company-provided equipment, telephone systems, and electronic communication platforms are required.

Employees may be required to report to the pharmacy for training, meetings, equipment needs, or other operational purposes. When working onsite, employees must follow all pharmacy safety procedures and use personal protective equipment when required.

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Paid holidays
• Retirement plan with company match
• Employee-paid voluntary benefit options available through payroll deductions
• Training and professional development opportunities

About Us

Capstone Health, LLC dba Capstone Vital Care is a proud franchise of Vital Care Infusion Services, Inc., leading the way in home infusion therapy across Alabama, Florida, Georgia, Kentucky, Mississippi, and Ohio. As an established provider of home infusion therapy services, Capstone Health, LLC dba Capstone Vital Care is dedicated to delivering high-quality, patient-centered care in the comfort of our patients' homes. Our team of pharmacists, nurses, and support staff work collaboratively to improve health outcomes through personalized medication management and clinical support.

Mission Statement

Capstone Health, LLC dba Capstone Vital Care delivers efficient, expedient, and exemplary infusion services to patients and referral sources throughout the communities we serve.

Our Vision

Capstone Health, LLC dba Capstone Vital Care will be the preferred infusion pharmacy for specialty infusions and other infusion therapy services throughout Alabama, Florida, Georgia, Kentucky, Mississippi, and Ohio. We recognize the value of all our resources, starting with employees first. We focus our services and provide a "no quit approach" to those patients who have chosen us as their preferred infusion pharmacy.

Equal Employment Opportunity

Capstone Vital Care is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, pregnancy, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.