Director, Revenue Cycle Management

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

📋 Description

• Take ownership of the complete revenue cycle, which includes verifying eligibility and benefits, capturing charges, coding, submitting claims, managing denials, processing appeals, following up on accounts receivable, billing patients, and posting cash.

• Oversee the configuration of Candid Health, incorporating payer rules, fee schedules, and claim edits.

• Develop a monitoring schedule and adjust billing rules based on data insights.

• Lead the revenue cycle workstream during the implementation of the Healthie EHR.

• Ensure accurate mapping of clinical documentation, encounter data, and charge flows into the billing system.

• Manage the cleanup and resolution of legacy claims from the previous system.

• Create and maintain a centralized source of truth for payer, plan, provider, and contract information.

• Develop revenue cycle reports, including cash forecasts, accounts receivable aging, denial trends, and yield by service line.

• Take responsibility for revenue cycle metrics and their interpretations.

• Handle payer escalations, underpayments, and assess payer performance.

• Collaborate with credentialing and payer enrollment teams to keep an up-to-date and billable provider roster.

• Lead, mentor, and develop a small revenue cycle management team, which includes the existing RCM Manager.

• Evaluate the current state, identify revenue leakage, and create a prioritized remediation strategy.

• Enhance clean claim rates, first-pass yield, denial rates, days in accounts receivable, and net collection rates.

⛳️ Requirements

• Over 7 years of experience in the healthcare revenue cycle.

• More than 3 years of experience in a leadership role or managing a function.

• Extensive experience in physician or practitioner billing, rather than just facility or hospital billing.

• Direct experience managing a modern billing or claims platform; Candid Health is strongly preferred, but Waystar, Availity, Office Ally, Change/Optum, or similar platforms will also be considered.

• Proven revenue cycle experience through an EHR implementation or migration.

• Proficient in CPT, HCPCS, ICD-10, modifiers, and payer-specific billing requirements.

• A successful history of reducing denials and accounts receivable days, with documented evidence of outcomes.

• Skilled in reconciling and validating complex data and creating structure where it is lacking.

• Direct experience managing commercial payer escalations, underpayments, and related performance challenges.

• Experience in telehealth, virtual care, or digital health billing is preferred.

• Familiarity with preventive services and ACA-mandated coverage, including lactation and maternal health benefits, is preferred.

• Experience with Healthie is preferred.

• Proficiency in SQL, BI tools, or advanced spreadsheet modeling is preferred.

• Experience working in a startup or small company environment is preferred.

• Capacity to work remotely and communicate asynchronously via Slack and email, as well as participate effectively in virtual meetings.

• Ability to thrive in a fast-paced team setting.

• Must possess a valid driver's license and REAL ID.

• Currently authorized to work full-time in the United States.

🏝️ Benefits

• Unlimited paid time off (PTO) along with company holidays.

• Eligibility for a 401(k) plan.

• Remote-first work with flexible options.

• Real scope and autonomy in your role.

• Direct access to leadership.

• Empowerment to implement changes in processes.

• Opportunity to establish the revenue cycle function from the ground up.