Director of Pharmacy RCM (Remote)

Coral Connect, LLC (“Coral”) is a technology-enabled service provider focused on reducing healthcare costs through intelligent data management, pharmacy optimization, and value-driven sourcing. Our mission is to make specialty care more accessible, efficient, and equitable by improving operations at community care organizations, infusion centers, and specialty providers.

Job Overview

The Director of Pharmacy Revenue Cycle Management (RCM) provides strategic leadership and operational oversight for Coral’s infusion pharmacy revenue cycle performance across managed service clients. This role serves as the primary infusion pharmacy RCM subject matter expert (SME), aligning infusion operations, payor strategy, and revenue cycle execution to drive scalable, high-performance outcomes. The Director partners cross-functionally with internal service lines and external clients to standardize workflows, optimize reimbursement, and enable consistent, data-driven performance across Coral’s platform.

Responsibilities

Your key responsibilities will include:

Strategic Leadership

• Drive development and deployment of standardized RCM playbooks across all infusion and pharmacy clients.
• Partner with Coral’s technology team to define requirements for RCM enablement within Coral’s platform (e.g., referral optimization routing, workflow visibility, denial tracking, reimbursement analytics).
• Provide strategic direction for infusion service operations across multiple client organizations.
• Serve as the infusion therapy subject matter expert for the RCM organization.
• Develop standardized best practices for infusion workflows, documentation, and revenue cycle processes.

Client Relationship Management

• Act as a senior-level advisor and operational partner for infusion clients.
• Lead quarterly business reviews (QBRs) with client leadership focused on financial performance, reimbursement trends, and optimization roadmap.
• Provide recommendations and influence client decisions related to site-of-care strategy, buy-and-bill versus pharmacy benefits, payor contracting alignment, and overall infusion program efficiency, reimbursement, and patient access.

Infusion Program Optimization

• Evaluate and optimize site-of-care alignment to ensure delivery in the most cost-effective and reimbursable setting.
• Assess buy-and-bill vs. clear bagging vs. white bagging models and recommend optimal approach.
• Partner with internal stakeholders to align drug acquisition strategy with reimbursement and GPO performance.
• Evaluate infusion workflows including referral intake, insurance verification, prior authorization, scheduling, clinical documentation, and billing readiness.
• Identify opportunities to improve reimbursement for infusion medications, administration services, and related supplies.
• Support optimization of drug utilization, payor contracting considerations, and infusion service delivery models.

Revenue Cycle Collaboration

• Provide subject matter expertise on medical vs. pharmacy benefit billing pathways, including cross-walk considerations.
• Support development of payor-specific billing and documentation strategies.
• Partner closely with RCM leadership to align clinical infusion operations with billing and reimbursement strategies.
• Provide guidance on infusion-specific billing requirements including but not limited to: drug billing using HCPCS/J-codes, National Drug Codes (NDC), infusion administration CPT codes, and drug wastage and modifier usage.
• Assist in resolving complex payor reimbursement issues and establish escalation frameworks for systemic issues and trends.

Operational Performance & Analytics

• Monitor key infusion and revenue cycle metrics across client accounts, including but not limited to: authorization turnaround times, infusion utilization, drug reimbursement performance, denial trends, and revenue per infusion visit.
• Develop operational improvement plans based on performance data.
• Partner with analytics teams to ensure data integrity, reporting consistency, and actionable insights.
• Drive adoption of real-time performance monitoring tools (e.g., denial tracking, authorization visibility).

Regulatory Compliance

• Ensure compliance with regulatory standards including payor requirements, CMS guidelines (including billing and documentation requirements), OIG guidance related to infusion and reimbursement, state-specific infusion and pharmacy regulations, and industry best practices.
• Maintain awareness of evolving reimbursement policies impacting infusion therapy.
• Support overall departmental compliance and audit readiness.

Team Leadership & Development

• Provide guidance and support to internal RCM managers and operational teams supporting pharmacy infusion clients.
• Assist in developing training materials, competency frameworks, and operational protocols related to infusion services.
• Mentor staff on infusion therapy workflows and reimbursement considerations.

Process Improvement

• Identify operational inefficiencies and implement standardized solutions across client accounts, ensuring scalable operating models.
• Drive continuous improvement and workflow optimization through automation, technology adoption, and workflow redesign.

Qualifications

• 5 years of healthcare experience with significant experience in infusion pharmacy intake and billing services
• 3 years of leadership or director-level experience
• Strong understanding of infusion reimbursement, payor policies, and revenue cycle workflows
• Experience working with outpatient infusion centers, specialty pharmacy, oncology infusion, or hospital-based infusion services
• Demonstrated experience managing multi-site or multi-client environments
• Deep knowledge of infusion therapy operations and reimbursement models
• Strong strategic thinking and operational leadership abilities
• Excellent client relationship and executive communication skills
• Ability to analyze operational and financial performance metrics
• Strong problem-solving and process improvement skills
• Ability to manage multiple client engagements simultaneously

Education

High school diploma or equivalent.

License Requirement

N/A

Job Benefits

Health, Dental, Vision, Life, 401k, Paid Time Off.

Location

Remote with limited travel to client locations, internal business meetings, and other locations as needed.