RCM Operations Lead

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

📋 Description

• Take charge of comprehensive billing operations throughout the entire claims lifecycle. This includes front-end insurance verification and prior authorization, as well as claim submission, follow-up, resolution of denials/rejections, and back-end reporting.

• Lead and oversee a team of more than 4 offshore support staff. Establish priorities, assign workstreams, review outputs, and ensure the team remains on schedule. Act as the escalation point for any issues that arise and guarantee that processes are consistently and accurately executed by the team.

• Manage a substantial volume of billing inquiries and escalations from both vendors and internal teams—investigating patient responsibility questions, addressing vendor escalations, and prioritizing urgent matters such as medical record subpoenas and contacts from collection agencies.

• Assist with ad-hoc Revenue Cycle Management (RCM) projects, which may include state launches, new payer setups, provider enrollment, and addressing credentialing gaps for current clinicians.

⛳️ Requirements

• A minimum of 5 years of hands-on experience in Revenue Cycle Management (RCM).

• Strong understanding of the claims lifecycle, including denials, rejections, adjustments, and resubmissions. Proficient in using Availity and standard provider portals.

• Ownership mentality. You maintain organized workflows, proactively follow up on pending items, and approach the function as if it is yours to manage.

• Effective communicator. You highlight key information in a manner that others can easily act upon, and you remain responsive to the teams that rely on you.

• Adaptable in a fast-paced environment. Experience in startups or high-growth settings is preferred. You successfully manage multiple workstreams at once and do not require extensive oversight to stay organized.

• You set high standards. You are comfortable challenging the status quo, identifying issues, and holding both vendors and internal teams accountable to elevated expectations, even in the absence of formal authority.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and career advancement.

• Flexible work schedule and remote work options.