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 systemsPreferred 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 programsCore 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 AccountabilityKey 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 Read LessOso Home Care is hiring a full-time Pharmacy Technician. Must have sterile compounding experience. We are seeking an energetic, customer-focused, team player for fast-paced home infusion pharmacy. We are located in Burbank, CA,
Hours: Monday to Friday with rotating weekends.
Job Duties:
Sterile compounding.Communicating with various healthcare professionals, to include authorizations and benefit teams.Providing outstanding customer service.Job Requirements:
High school diploma.Active Pharmacy Technician license.Excellent customer service skills.Proficient in basic mathematics.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessThe Home Infusion Biller is responsible for managing reimbursement activities related to home infusion services. This includes researching and resolving claim rejections and denials, documenting all account actions, and ensuring timely follow-up with Medicare, Medi-Cal, Managed Medi-Cal, and commercial payers (HMO and PPO). The position may qualify for collection-based bonuses.
Monday to Friday 8 am - 4:30 pm.
Experience
Minimum of 2 years of medical billing or collections experience in Home Infusion.Experience with CPR+ (Mediware) and/or CareTend software is a plus.Must have a solid understanding of medical terminology and insurance laws/guidelines.Skills
Proficient in medical billing and CMS reimbursement guidelinesIn-depth knowledge of insurance verification and eligibility (Medicare Parts A-D, Medi-Cal, commercial plans)Familiarity with ICD-10, HCPCS, and NDC codingExperience with prior authorization submissions and appealsCompetent in Microsoft Office (Word, Excel, Outlook) and EMR platformsExcellent analytical, time management, and organizational skillsStrong math skills with the ability to calculate using whole numbers, fractions, and decimalsWe are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is hiring a full-time Pharmacy Technician. Must have sterile compounding experience. We are seeking an energetic, customer-focused, team player for fast-paced home infusion pharmacy. We are located in Irvine, CA, where the 405 and 55 freeways meet.
Hours: Monday to Friday with rotating weekends.
Job Duties:
Sterile compounding.Communicating with various healthcare professionals, to include authorizations and benefit teams.Providing outstanding customer service.Job Requirements:
High school diploma.Active Pharmacy Technician license.Excellent customer service skills.Proficient in basic mathematics.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is looking for an experienced Intake Care Coordinator. Candidate must know HCPC, ICD10 & CPT codes. Will be responsible for taking Infusion Therapy and Home Health referrals from referral sources. Must be capable of verifying benefits, entering patient demographics into the computer system, communicating with other departments regarding the status of referrals, and notifying patients/families regarding coverage and payment responsibilities. Ensures that insurance verification is completed, and authorizations are obtained before giving the referral to the Pharmacist.
Work Schedule: Full-Time
Responsibilities:
Conduct initial patient assessments and gather necessary medical and insurance information.Coordinate with healthcare providers to obtain prescriptions, medical orders, and patient histories.Verify insurance coverage and obtain prior authorizations as needed.Schedule and coordinate home infusion services, ensuring timely delivery of medications and supplies.Maintain accurate and up-to-date patient records in compliance with regulatory standards.Provide exceptional customer service and support to patients and their families throughout the intake process.Collaborate with the clinical team to ensure smooth transitions and continuity of care.Qualifications:
High school diploma or equivalent; associate or bachelor's degree preferred.Previous experience in a healthcare setting, preferably in home infusion or pharmacy services.Strong organizational and multitasking skills with attention to detail.Excellent communication and interpersonal skills.Proficiency in electronic health records (EHR) and Microsoft Office Suite.Knowledge of insurance verification and prior authorization processes.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is hiring a full-time Pharmacy Technician. We are seeking an energetic, customer-focused, team player for fast-paced home infusion pharmacy. We are located in Irvine, CA, where the 405 and 55 freeways meet.
Hours: Monday to Friday with rotating weekends.
Job Duties:
Receive written prescription or refill requests and verify that information is complete and accurate. Communicating with various healthcare professionals, to include authorizations and benefit teams.Providing outstanding customer service.Job Requirements:
High school diploma.Active Pharmacy Technician license.Excellent customer service skills.Proficient in basic mathematics.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is seeking a Clinical Pharmacist for its Burbank Home Infusion Pharmacy. This is a fantastic opportunity to join a team of talented, enthusiastic healthcare professionals that provide outstanding patient care from a dynamic setting. This position offers Clinical Pharmacists the opportunity to work with Physicians, Nurses, and patients to manage infusion therapies.
Hours: Start time between 9:00 am and 10:00 am (8 hours a day), Monday to Friday, with rotating weekends
Candidates must have:
Registered Pharmacy License.At least 1 year of Home Infusion or Specialty Pharmacy experience.IV Dosing & Sterile Compounding
Prepare and dispense intravenous medications, ensuring proper dosages, sterility, and safety protocols.
Perform aseptic technique for compounding and IV preparation, ensuring compliance with USP standards.
TPN Formulations
Formulate and adjust Total Parenteral Nutrition (TPN) solutions based on individual patient needs, including fluid volume, electrolytes, vitamins, and trace elements.
Vancomycin Monitoring
Monitor Vancomycin therapy, adjusting dosing based on therapeutic drug levels, renal function, and patient response.
Ensure proper blood levels are maintained within therapeutic range to avoid toxicity or suboptimal effects.
Ambulatory Infusion Pump Programming
Program and set up ambulatory infusion pumps for home-based therapy, ensuring proper flow rates, alarm settings, and patient safety.
Provide patient education on pump usage, troubleshooting, and emergency procedures.
Prescription Entry & Verification
Accurately enter and verify prescriptions, ensuring correct dosages, drug interactions, and patient history.
Process an average of 20-25 prescriptions per day, ensuring timely and accurate dispensing.
New Patient Intake & Consultation
Process an average of 7-8 new patient cases per day, assessing their medication needs and history to ensure appropriate therapy.
Provide consultation and patient counseling, ensuring understanding of their medications, treatment plans, and potential side effects.
Delivery Ticket Management
Manage delivery tickets for prescriptions and medical supplies, ensuring timely and accurate fulfillment for home or facility delivery.
Collaboration & Communication
Work closely with healthcare teams, including physicians, nurses, and other pharmacists, to ensure optimal patient care and medication management.
Quality Control & Compliance
Adhere to all pharmacy laws, regulations, and best practices for patient safety and medication accuracy.
Participate in continuous quality improvement efforts, ensuring compliance with state and federal guidelines.
Candidate must have strong phone and communication skills to counsel patients.We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is hiring a full-time Authorizations Specialist. We are located in Irvine, CA, where the 405 and 55 freeways meet.
Hours: In office, Monday to Friday, 9:30 am - 6 pm.
Job Duties:
Verify eligibility and benefits.Submit authorizations.Authorization follow-up.Job Qualifications:
2 years of prior authorization experience.Experience in submitting authorization requests to medical payers such as Blue Cross, Blue Shield, Aetna, and other PPO & HMO payers.Knowledge of HCPCS, ICD-10 & CPT codes.Candidate must possess good computer skills.Knowledge of Medicare guidelines preferred.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned Corporation founded in 1984.
https://osohomecare.com
OSO Home Care is an equal opportunity employer. OSO Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessLVN Case Manager
Job Description
Oso Home Care Inc. is looking to hire a full-time LVN case manager. Our main office is located in Irvine, CA where the 405 and 55 freeways meet. Candidate must be IV certified. This is an in office/in clinic LVN role supporting our home and clinic infusion patients and nurses. Training to take place in our Irvine location and then transfer to our Long Beach, CA ambulatory infusion center.
Hours:
Monday through Friday, 8:00 am – 7:00 pm (8 hours shifts: varying starting/closing shifts to support business needs)
Responsibilities:
Organize patient's plan of care from the moment the patient starts on service to the moment they discharge from the agency.Communicate with providers, insurance companies, nurses, pharmacy staff, and patients/families.Assist AIC nurses in obtaining provider orders, starting IV’s & case managing all aspects of patient care needs.Willingness to learn all aspects of infusion therapy within the scope of an LVN.Requirements:
Current unrestricted CA LVN license.IV certification.Strong communication, organizational, and documentation skills are a must.Ability to work independently and as part of a teamFlexibility to train/interview in our Irvine location with future possibility to transfer to our Long Beach ambulatory infusion center location when training is complete.Preferred:
Experience with PICC lines, implanted ports, and IV therapy within LVN scope of practice.Experience starting IV’s and drawing blood.Spanish speaking is a plus but not required.Prior experience working in a fast-paced clinical support environment.Oso Home Care Inc is an Equal Opportunity Employer and complies with all local, state, and federal laws.
Applicant and employee privacy policy can be found at: https://osohomecare.com
Read LessOso Home Care is seeking an experienced Major Medical Collector to join our Billing & Reimbursement Department. Since 1984, Oso Home Care has been a leader in specialty home infusion pharmacy, ambulatory infusion center (AIC), and home health services throughout Southern California.
The Major Medical Collector is responsible for managing complex insurance accounts receivable for specialty home infusion pharmacy, infusion nursing services, ambulatory infusion center (AIC), and home health claims. This position focuses on maximizing reimbursement by aggressively pursuing payment of outstanding claims, researching payment discrepancies, resolving denials, preparing appeals, and ensuring timely collections from Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, Commercial PPO/HMO plans, Workers' Compensation, and other third-party payers.
This role requires an advanced understanding of specialty infusion medications, home infusion billing, pharmacy reimbursement methodologies, medical necessity requirements, prior authorization, and payer-specific reimbursement guidelines. The Major Medical Collector serves as a subject matter expert and collaborates closely with Intake, Authorization Specialists, Pharmacists, Nurses, Billing, Reimbursement, Managed Care, and Finance to reduce accounts receivable aging while improving reimbursement performance.
This position is offered under a hybrid work model.
Essential Duties and ResponsibilitiesAccounts Receivable ManagementManage an assigned portfolio of complex insurance accounts receivable for specialty home infusion pharmacy and home health services.Review daily, weekly, and monthly aging reports to prioritize collection activities.Research and resolve unpaid, underpaid, denied, and suspended claims.Monitor high-dollar infusion claims to ensure timely reimbursement.Identify reimbursement barriers and develop strategies to accelerate payment.Maintain productivity standards for insurance follow-up and collections.Insurance CollectionsConduct comprehensive insurance follow-up with:MedicareMedicare AdvantageMedi-CalManaged Medi-CalCommercial PPO and HMO plansIPA Medical GroupsWorkers' Compensation carriersThird-party administratorsCommunicate directly with insurance representatives regarding outstanding claims, payment status, appeals, authorizations, and reimbursement issues.Resolve coordination of benefits (COB), eligibility issues, medical necessity denials, authorization discrepancies, and contractual payment variances.Escalate unresolved payer issues appropriately while maintaining professional payer relationships.Denials & AppealsInvestigate claim denials to determine root causes.Prepare first-level, second-level, and external appeals with supporting clinical and billing documentation.Coordinate with physicians, pharmacists, nurses, authorization specialists, and intake staff to obtain documentation supporting medical necessity.Monitor appeal deadlines and payer response timelines.Track appeal outcomes and identify trends impacting reimbursement.Recommend operational improvements to reduce future denials.Specialty Home Infusion ReimbursementUtilize advanced knowledge of specialty infusion billing requirements for therapies including, but not limited to:IV AntibioticsIV Immunoglobulin (IVIG)Subcutaneous Immunoglobulin (SCIG)Total Parenteral Nutrition (TPN)Hydration TherapyBiologic MedicationsMonoclonal AntibodiesAnti-infective TherapiesSpecialty Injectable MedicationsUnderstand reimbursement methodologies for medications, nursing services, infusion pumps, supplies, and pharmacy dispensing fees.Review payer policies related to infusion therapy coverage and reimbursement.Revenue Cycle CollaborationCollaborate closely with:
Intake CoordinatorsAuthorization SpecialistsBenefits Verification SpecialistsClinical PharmacistsPharmacy TechniciansHome Infusion NursesAmbulatory Infusion Center (AIC)Billing DepartmentManaged CareFinance Departmentto resolve reimbursement issues before and after claim submission.
Provide recommendations that improve clean claim rates, reduce denials, and strengthen overall revenue cycle performance.
Financial AnalysisReview Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs).Identify payment variances, underpayments, duplicate payments, and contractual discrepancies.Verify reimbursement against payer contracts and fee schedules.Assist leadership in identifying payer trends affecting revenue.Prepare documentation supporting recovery of underpaid claims.DocumentationMaintain complete documentation of all collection activities within the billing system.Document payer communications, appeals, claim corrections, payment status, contractual adjustments, and follow-up efforts.Ensure account notes support audit readiness and continuity of follow-up.Quality ImprovementParticipate in departmental productivity meetings and revenue cycle review sessions.Identify trends contributing to reimbursement delays.Recommend workflow improvements that increase reimbursement and reduce accounts receivable aging.Assist with internal audits, payer audits, and accreditation activities.Regulatory ComplianceMaintain compliance with:
Medicare Parts B & D billing regulationsMedi-Cal regulationsCommercial payer reimbursement guidelinesCMS regulationsHIPAA Privacy and Security RulesACHC Accreditation StandardsCalifornia Board of Pharmacy regulationsCompany policies and proceduresMaintain strict confidentiality of all protected health information.
Minimum QualificationsHigh School Diploma or equivalent required.Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Medical Billing, or related field preferred.Minimum 5 years of medical collections experience with a strong emphasis on specialty home infusion pharmacy required.Experience with home health reimbursement strongly preferred.Experience managing high-dollar infusion claims and specialty medication reimbursement.Experience with CPR+ (Mediware), CareTend, Brightree, EnterpriseRx, or similar billing platforms preferred.Knowledge, Skills & AbilitiesRequired KnowledgeAdvanced knowledge of specialty home infusion reimbursement.Home infusion pharmacy billing methodologies.Medicare Parts B & D.Medi-Cal and Managed Medi-Cal reimbursement.Commercial PPO and HMO reimbursement.Pharmacy and nursing billing requirements.HCPCS, CPT, ICD-10-CM, modifiers, revenue codes, and NDC billing.Medical necessity guidelines.Prior authorization requirements.Explanation of Benefits (EOBs).Electronic Remittance Advice (ERA).Coordination of Benefits (COB).Appeals and payer dispute resolution.Required SkillsStrong analytical and critical thinking skills.Excellent organizational and time management abilities.Advanced problem-solving skills.Strong negotiation skills when working with insurance carriers.Excellent written and verbal communication.Intermediate to advanced Microsoft Excel skills.Ability to manage large volumes of complex accounts while meeting productivity standards.Core CompetenciesSpecialty Home Infusion ExpertiseRevenue Cycle ManagementInsurance CollectionsAccounts Receivable ManagementAppeals & Denial ResolutionFinancial AnalysisRegulatory ComplianceAttention to DetailCritical ThinkingCustomer ServiceAccountabilityTeam CollaborationProblem SolvingContinuous ImprovementPerformance ExpectationsThe Major Medical Collector is expected to:
Meet or exceed departmental collection and productivity goals.Reduce insurance accounts receivable aging.Maximize reimbursement for specialty infusion pharmacy and home health services.Maintain high-quality documentation of all collection activities.Resolve denials and appeals within established turnaround times.Maintain compliance with all payer, regulatory, accreditation, and company requirements.Identify reimbursement trends and contribute to process improvement initiatives.Support Oso Home Care's commitment to financial stewardship while ensuring patients continue to receive medically necessary infusion therapies.Why Join Oso Home Care?Founded in 1984, Oso Home Care is a privately owned leader in specialty home infusion pharmacy, ambulatory infusion center services, and home health care. We are dedicated to delivering exceptional patient care through clinical excellence, innovation, and compassionate service.
At Oso Home Care, our Billing & Reimbursement team plays a vital role in supporting patient access to life-sustaining infusion therapies. We offer a collaborative, family-oriented work environment, opportunities for professional growth, and the chance to make a meaningful impact on both our patients and our organization.
Oso Home Care is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by federal, state, or local law.
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