Director of Revenue Cycle Management – Credentialing

This is a fully remote position, open to applicants in United States.

📋 Description

• Take full ownership of the complete revenue cycle, which encompasses charge capture, claim submission, denial management, payment posting, accounts receivable follow-up, patient billing, and collections.

• Oversee RCM execution by coordinating internal staff and external vendors as needed, ensuring SLA adherence, performance monitoring, escalation processes, and complete transparency regarding work performed on behalf of the organization.

• Spearhead the ongoing enhancement of RCM procedures and the associated technology stack, emphasizing financial transparency within clinical workflows and minimizing manual handoffs.

• Design and execute new RCM processes and workflows aimed at improving scalability, diminishing manual tasks, and ensuring uniform execution across internal teams.

• Create and maintain reporting and analytics focusing on denial trends, payer performance, accounts receivable aging, reimbursement, provider productivity, and collection rates.

• Initiate strategies to lower denial rates, speed up cash collection, and enhance net collection percentage.

• Regularly assess the ideal blend of internal and external RCM resources and lead the growth or reorganization of those resources as the organization expands.

• Collaborate with clinical operations, finance, and technology teams to synchronize RCM priorities with broader organizational objectives.

• Direct and mentor the credentialing function, including the direct management of Credentialing Specialist(s) and any future team expansion.

• Act as the organization’s expert on provider credentialing, payer enrollment, and the link between credentialing operations and revenue cycle outcomes.

• Ensure prompt initial credentialing, re-credentialing, and payer enrollment for both government and commercial payers in every state of operation.

• Streamline credentialing turnaround times and proactively manage payer enrollment schedules to avoid revenue disruptions.

• Maintain precise provider records and guarantee data accuracy between credentialing systems (CAQH, payer portals, internal databases) and billing systems.

• Examine credentialing- and enrollment-related denial trends and implement corrective measures.

• Stay updated on payer regulations, telehealth credentialing requirements, and licensing rules across all operational states.

• Develop a long-term RCM and credentialing strategy aligned with the organization’s growth.

• Prepare regular reports for the SVP of Clinical Operations and executive leadership regarding RCM and credentialing performance, risks, and opportunities.

• Assist in audits, compliance evaluations, and process enhancements across both functions.

• Represent RCM and credentialing in cross-functional projects, including payer contracting, market expansion, and new clinical program launches.

⛳️ Requirements

• A Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field is required; an advanced degree is preferred.

• Over 7 years of progressive experience in healthcare revenue cycle management, including leadership roles.

• Proven experience leading both RCM operations and provider credentialing/payer enrollment functions.

• Strong background in multi-state, multi-payer environments; experience in telehealth or virtual specialty care is highly preferred.

• Experience overseeing RCM operations across internal teams and external vendors, including SLA management and performance accountability.

• Working knowledge of clearinghouses, EMR billing modules, ERA processing, and comprehensive claims workflows.

• Familiarity with specialty care billing workflows, including chronic care management and transitional care management, is preferred.

• Extensive knowledge of government payer enrollment requirements (Medicare, Medicaid, VA, Tricare) and commercial payer enrollment.

• Proficient with credentialing platforms and payer portals (e.g., CAQH).

• Exceptional analytical skills with the capability to convert RCM and credentialing data into operational insights and executive reports.

• Strong project management abilities with the capacity to oversee multiple workstreams, providers, and payer relationships concurrently.

• Excellent communication skills and the ability to foster relationships across clinical, operational, technology, and executive teams.

• High attention to detail and accuracy, with the ability to meet strict deadlines.

🏝️ Benefits

• We are mission-driven: we're revolutionizing the way cardiovascular care is delivered.

• We are fast-paced & agile: we move quickly, iterate often, and value experimentation.

• We are remote-first: flexibility, autonomy, and trust are at the core of how we operate.

• We care about diversity: diversity allows us to build an excellent patient experience.

• We care about each other: we are stronger together through a culture of mutual respect and active support.

• We are an equal opportunity employer: we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.