CarepathRx

Sales

• Responsible for opening new accounts, while maintaining relationships with existing accounts
• Responsible for achieving sales effectiveness within an assigned area with the goal of meeting or surpassing individual and team goals each quarter
• Responsible for transitioning patients to our pharmacy
• Able to utilize company database/tools to identify key accounts and maximize referral potential
• Maintain and document a call cycle that ensures proper follow up, detailing and competent account management
• Work closely in collaboration with Operations and other inside counterparts to provide a seamless, patient and office focused message to accounts
• Build and extend relationships to pharmaceutical counterparts
• Support all specialty pharmacy activity i.e., assisting in procuring missing documentation, communicating information to and from MD offices, and communicating benefit information etc.
• Responsible for efficient regional budget planning and controlling
• Comply with all company policies and procedures
• Assist in formulating and executing MBO’s as developed by the Sales Leadership Team where applicable
• Attend and participate in sales meetings, training programs, conventions and in-services as instructed by the Sales Leadership Team
• Communicate all information regarding competitors, issues affecting territory, business threats and related information to the associated Regional Director of Sales / Senior Regional Director of Sales, VP of Outside Sales, and other relevant persons within the organization
• Participate and perform other duties as assigned by leadership

Director, Infusion Sales IVIG – Multiple Markets

Business Analyst

• Participate in meetings with IT, Finance and Business Administration management to understand key metrics and drivers of organizational performance outcomes and develop action plans to address identified issues.
• Demonstrate the ability to effectively incorporate identified reporting requirements into assigned areas of work.
• Promote a culture of collaborative, customer-focused service delivery with both internal and external team resources.
• Collaborate with sales & operational teams to review business processes and identify opportunities for improve outcomes and assist the team in hitting goals.
• Create high-quality, executive-level presentation material summarizing key projects, issues, and/or reporting metrics.
• Extract and analyze financial/operational data set(s) for assigned book of business, including proactive determination of root cause drivers of significant variance.
• Analyze and identify trends and issues and work with appropriate personnel/departments to resolve.
• Prepare moderately complex financial/operational reporting metrics, validating the quality and accuracy of the data, and ensuring that reports are published according to pre-defined delivery dates.
• Maintenance, development, and deployment of Power BI dashboards that facilitate operations & sales teams.
• Reconciliation and understanding of existing datasets & how it both relates to or differs from existing reporting.

Customer Success Manager

• Deliver overall value to the client and management services organization (MSO)
• Establish and maintain relationships with Health System Leadership and key system-wide decision makers
• Develop and execute a comprehensive partner strategy aligned with the MSO’s long-term objectives and the Health Systems goals
• Serve as a key advisor to the President, Chief Operating Officer (COO), and Chief Client Officer (CCO) on all matters related to contractual engagements and alliances.
• Enhance operational performance through collaboration with MSO (Finance, Admissions, Pharmacy, and RCM)
• Support the negotiation and structure of client agreements to maximize value for all parties.
• Establish and manage partner performance metrics and communication systems.
• Collaborate with Health System leadership to gain interdepartmental support
• Develop joint go-to-market strategies with partners and oversee introduction and execution of these strategies.
• Participate in the planning and execution of annual budgets for MSO and Client
• Establish KPIs and partner performance dashboards/quarterly QA meetings to monitor success, impact, and ROI.
• Strict adherence to all Policies & Procedures
• Performs other duties as assigned

Vice President, Client Success

Analyst

• Lead and execute complex administrative projects and initiatives
• Serve as a strategic partner to senior leaders, anticipating needs and managing logistics
• Develop and implement models, procedures, and tools to improve administrative efficiency
• Monitor trends and identify opportunities for continuous improvement
• Provide guidance and mentorship to junior professionals
• Manage sensitive information with discretion and professionalism
• Coordinate cross-functional activities reporting needs and stakeholder communications
• Serve as a liaison between leadership and internal/external partners

Administrative Services Analyst

• Responsible for opening new accounts, while maintaining relationships with existing accounts.
• Responsible for achieving sales effectiveness within an assigned area with the goal of meeting or surpassing individual and team goals each quarter.
• Responsible for transitioning patients to our pharmacy
• Able to utilize company database/tools to identify key accounts and maximize referral potential.
• Maintain and document a call cycle that ensures proper follow up, detailing and competent account management.
• Work closely in collaboration with Operations and other inside counterparts to provide a seamless, patient and office focused message to accounts.
• Build and extend relationships to pharmaceutical counterparts.
• Support all specialty pharmacy activity i.e., assisting in procuring missing documentation, communicating information to and from MD offices, and communicating benefit information etc.
• Responsible for efficient regional budget planning and controlling.
• Comply with all company policies and procedures.
• Assist in formulating and executing MBO’s as developed by the Sales Leadership Team where applicable.
• Attend and participate in sales meetings, training programs, conventions and in-services as instructed by the Sales Leadership Team.
• Communicate all information regarding competitors, issues affecting territory, business threats and related information to the associated Regional Director of Sales / Senior Regional Director of Sales, VP of Outside Sales, and other relevant persons within the organization.
• Participate and perform other duties as assigned by leadership.

Director, Infusion Sales – IVIG

IT Support

• The Business Unit Specialist is responsible for the set up and accuracy of patient management system revenue cycle related files.
• This role involves coding inventory, loading and/or verifying set up for payers, contracts and fee schedules in addition to other projects as assigned.
• Evaluates and documents department needs and all aspects of business processes both operational and financial, including current process analysis; and proposed revisions to optimize business processes.
• Assist in designing and executing solutions that meet System's/Divisions' strategic objectives.
• Assures quality of information technology solutions and system upgrades through business case and application-level testing; validates test results to initial business needs.
• Work with Information Services staff to design, test and deploy appropriate hardware solutions, connectivity requirements and interface solutions, as appropriate.
• Play a key role in month end close operations.
• Builds and maintains system maintenance files, i.e., fee schedules, inventory set up/pricing, new payers, etc.
• Provide documentation and training as needed.
• Provide service according to the expectations of policies/procedures and standards developed around the revenue cycle department.
• Manage routine & special projects which may require oversight of other departments' work and coordination of a wide variety of functions.
• Develop and maintain working relationships with Revenue Cycle departments, and external contacts as appropriate.
• Maintain policies and procedures of the team / department as needed.
• Identify departmental needs and report to management as appropriate.
• Meet deadlines and turnaround times set by department leadership.
• Provide guidance to peers and serve as reference point for questions as needed.

Business Unit Specialist

Account Manager

• Serve as the primary relationship owner for assigned accounts, ensuring consistent engagement and satisfaction
• Maintain ≥95% of baseline revenue annually through proactive communication and partnership management
• Conduct regular business reviews to assess performance, identify opportunities, and reinforce value
• Identify and close opportunities to add new PipelineRx services to existing clients
• Expand service adoption across additional hospitals within a health system or IDN
• Partner with internal stakeholders (Sales, Clinical Operations, Product, Finance) to develop tailored growth strategies for each account
• Develop and execute strategic account plans aligned with client goals and PipelineRx business objectives
• Collaborate with the broader Sales and Operations teams to ensure seamless client experiences
• Track account metrics, revenue performance, and contract renewals to support retention and growth goals

Collections

• Manage third-party billing and collections
• Ensure timely and accurate payment of claims
• Process payer appeals
• Investigate denials and process rejections
• Identify root causes of payment issues
• Resolve discrepancies and maximize reimbursement
• Document all collections activity in patient collections notes
• Process all Payer appeal requests within the time frame required by the Payer

Collections Specialist

• support and be a resource for the Account Manager team for both Infusion and Specialty Pharmacy specific to customer and patient needs.
• execute the daily functions of the insurance verification area including verification of insurance coverage
• entering, and updating patient demographics into the patient management system
• communication of financial responsibility and securing reimbursement related paperwork.
• additional responsibilities may include coordinating new/existing patient services with patient/caregiver, nursing, and operations.
• Naming incoming faxes.
• Payment Agreements.
• Performs daily follow up with hospital staff to check on possible discharges under Account Manager supervision.
• Coordinates documentation as required by payers for ABN.
• Notifies agencies when deliveries will arrive and fax orders to agencies.
• Enters and updates patient demographics and services into the patient management system.
• Completes insurance checks on a daily basis as needed under Account Manager supervision.

Associate Account Manager

Therapist

• Provides respiratory care to patients in alternate sites in accordance to AHRE’s policies and procedures
• Utilizes all of the resources available within the agency and community to accomplish care objectives
• Maintains complete and accurate patient files by updating all documents per company policy and procedures
• Performs clinical assessments as needed and reports results and recommendations to the referral source and/or physician

Respiratory Therapist

Business Development Rep

• Reporting to the Senior Vice President – Customer Success, responsible for maximizing a client base and strengthening existing relationships
• Achieve defined sales targets within an agreed expense budget
• Open new accounts while maintaining relationships with existing ones
• Qualify revenue potential and payor mix in new and existing accounts
• Collaborate with Operations and internal teams to deliver seamless and patient-focused messages to accounts
• Complete timely sales and expense reports and conduct a minimum of 10-12 quality sales calls weekly with key decision-makers

Vice President, Business Development – Specialty Pharmacy, Infusion Services

Onboarding Specialist

• Responsible for performing select activities related to the clinical management and order setup of specialty patients under the supervision of a licensed pharmacist.
• Communicating with patients, caregivers, and medical staff to accurately coordinate patient deliveries for home and office patients.
• Make outbound and receive inbound phone calls from patients, caregivers, and medical staff.
• Perform follow up calls to patients, caregivers, and medical staff as needed and under the direction of a licensed pharmacist.
• Provide support to specialty pharmacy team, pharmacy distribution and operations including but not limited onboarding of new Specialty patients.
• Maintain and update patient information and medication profiles, complete patient assessments and medication delivery setup under direct supervision of a licensed pharmacist.
• Provide appropriate and accurate documentation in patient medical record.
• Accurately provide copay information to the patient and process payments.
• Obtain all information required by Accreditation standards and clinical review by a licensed pharmacist.
• Maintain or exceed designated quality and productions standards.
• Provide excellent internal and external customer service, maintaining a service orientation in all interpersonal relations that conveys a positive, professional image.
• Act as a conduit of information between specialty pharmacy, operations, and patient, caregiver, or medical professional.

Onboarding Coordinator, Specialty

Insurance

• Manage the daily functions of the Insurance Verification area including verification of insurance coverage, re-verifying coverage for existing patients, enter and update patient demographics into the computer system, and securing reimbursement related paperwork
• Generate price/coverage quotes
• Train new team members
• Acts as the point of contact for Account Manager insurance verification, referrals and authorizations
• Work effectively and maintain expected productivity
• Verify insurance coverage, calculate costs and document details in the patient profile
• Medical vs pharmacy benefit determination
• Coordinates and communicates with Account Manager to expedite insurance checks, authorizations and referrals
• Generate a financial responsibility letter
• Review benefits with patient via phone
• Identify copay/foundation assistance and/or donated drug
• Track, monitor and secure necessary insurance documents
• Obtain prior authorizations as required
• Coordinate completion of Financial Assistance forms, payment agreements and waivers
• Assist with training new employees
• Organize and prioritize tasks to be completed
• Create new hospital and physician codes as needed
• Give high priority to client satisfaction and customer needs
• Demonstrates the ability to work effectively and maintain expected productivity

Insurance Verification Coordinator III

• Reporting to the Senior Vice President – Customer Success, the Vice President is responsible for maximizing a client base and strengthening existing relationships within an assigned territory.
• The individual will achieve defined sales targets within an agreed expense budget while demonstrating a strong understanding of the specialty pharmacy sector.
• Open new accounts while maintaining relationships with existing ones.
• Qualify revenue potential and payor mix in new and existing accounts.
• Achieve quarterly and annual sales effectiveness and individual/team goals.
• Collaborate with Operations and internal teams to deliver seamless and patient-focused messages to accounts.
• Build and maintain relationships with hospitals and health systems.

Vice President, Hospital Sales – Specialty Pharmacy, Infusion Services

• Manage the daily functions of the Insurance Verification area including verification of insurance coverage, re-verifying coverage for existing patients, enter and update patient demographics into the computer system, and securing reimbursement related paperwork
• Generate price/coverage quotes
• Work effectively and maintain expected productivity
• Verify insurance coverage, calculate costs and document details in the patient profile
• Generate a financial responsibility letter
• Review benefits with patient via phone
• Track, monitor and secure necessary insurance documents
• Obtain prior authorizations as required
• Coordinate completion of Financial Assistance forms, payment agreements and waivers
• Assist with training new employees
• Organize and prioritize tasks to be completed
• Create new hospital and physician codes as needed
• Give high priority to client satisfaction and customer needs
• Cooperate with other staff members when planning and organizing reimbursement activities
• Demonstrates the ability to work effectively and maintain expected productivity
• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks
• Assist with researching reimbursement issues
• Performs in accordance with system-wide competencies/behaviors
• Performs other duties as assigned

Insurance Verification Coordinator

• Obtains the patient referral via phone, fax, email and/or EMR
• Documents the referral details by creating the patient information sheet
• Identifies and documents the patient’s team assignment
• Creates patient entry for delivery management
• Enters/updates the patient profile, progress notes and home health information
• Acts as liaison between internal teams and the referral source
• Receives incoming calls, taking patient markers for new referrals
• Uploads documents to the patient’s medical record
• Manages electronic fax folder, determining the appropriate destination for the file
• Coordinates home health needs for the patient
• Acts as the team point of contact for assigned referral sources and/or therapies
• Assists with complex referrals/home health cases
• Trains/mentors new team members
• Assists Intake nurses with faxing and copying and distribution as needed
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned

• Responsible for performing select activities related to the clinical management and order setup of specialty patients under the supervision of a licensed pharmacist
• Provide support to specialty pharmacy team, pharmacy distribution and operations including but not limited onboarding of new Specialty patients
• Maintain and update patient information and medication profiles, complete patient assessments and medication delivery setup under direct supervision of a licensed pharmacist
• Provide appropriate and accurate documentation in patient medical record
• Accurately provide copay information to the patient and process payments

Onboarding Coordinator – Specialty

Financial Planning and Analysis

• Responsible for the billing and collection of copay assistance programs and foundation claims
• Identify billing trends
• Identify errors, correct claims and reprocess for reimbursement
• Read and interpret an EOB for accurate understanding of denial
• Contact payer, or patient as appropriate
• Document all collections activity in patient collections notes
• Document work performed/action taken on AR Aging Report and/or Over/Under Report
• Process all Payer appeal requests within the timeframe required by the Payer
• Ensure the timeliness and accuracy of billing
• Meet quality assurance, benchmark standards and maintain productivity levels as defined by management

Financial Assistance Specialist

• Obtains patient referral data from referral sources via phone
• Answer incoming phone calls pertaining to referrals
• Perform clerical duties as requested
• Documents initial referral information
• Identifies and documents patient team assignment
• Notifies intake coordinator of pending referrals
• Enters new patient information into computer system as needed
• Assists Intake with phone communication as needed
• Assures accurate transfer of patient insurance information
• Provides customer service to internal and external customers
• Performs in accordance with system-wide competencies/behaviors
• Performs other duties as assigned

Billing Specialist

Accounts Receivable Specialist is responsible for maintaining timely and accurate account receivables claims and systems. Responsibilities Verify all data around patient/claim and find out why it has been denied
Responsible for timely re-submission and accuracy for billing claims
Responsible for accurate submission of necessary documentation to the insurance companies with claims
Follow-up on all denials within 72 hours of receipt
Participate in accurate collection activities and accounts receivable management. This includes mailing second and third notices to past due accounts and letters of patient responsibility
Obtaining prior authorizations and medical records both via portals and phone
Post payments to accounts and submit check requests for accounts overpaid
Manage accounts receivable to reflect collectable dollars
Responsible for knowing and complying with applicable policies and procedures
Answering/handling incoming calls regarding claims that were billed/denied to both patients and insurance companies.
Making outbound calls to patients regarding need of updated insurance, documentation needed for continuation of care and billing insurances, prior authorizations, picking up rental equipment, transitioning care, etc.
Other duties as assigned