Director of Payer Ops and RCM

Job description

📌 ABOUT ALPACA HEALTH Alpaca Health enables clinicians to become entrepreneurs, starting in autism care. We help clinicians launch and scale their own clinics by providing AI-powered software, payer contracting, and full back-office infrastructure. Our goal is simple: shift power in healthcare away from large consolidated entities and back to clinicians. We are growing quickly and expanding into new states this year. The problems we are solving are operationally complex, high-stakes, and deeply meaningful for families. We've raised over $14M in funding from early-stage investors like Core Innovation Capital, Adverb Ventures, and South Park Commons, and are building for long-term category leadership. More importantly, we're serving hundreds of patients, while growing 30% MoM. WHAT YOU’LL DO Own the revenue engine and company-level outcomes You are accountable for the performance of the entire revenue cycle as a core driver of company growth and cash flow. You own collections, denial rate, clean claim rate, and days in A/R, and are responsible for building a function that delivers predictable, scalable revenue outcomes across markets, payers, and providers. Build and lead a high-performing RCM organization Recruit, develop, and lead a best-in-class RCM team, setting clear goals, operating cadence, and performance standards. Own the strategy and oversight of external vendors, ensuring alignment with internal goals and continuously raising the bar on execution and accountability. Shift RCM from reactive operations to a proactive growth system Define and execute the strategy to move from billing and follow-up to proactive revenue optimization. Architect end-to-end workflows that eliminate revenue leakage at the source—across intake, eligibility, authorization, documentation, and coding—so claims are clean, compliant, and paid quickly. Own payer performance and rate strategy Lead the strategy for payer performance across the lifecycle—from contracting through reimbursement. Partner on payer negotiations and re-negotiations, using data (utilization, outcomes, denial trends, network value) to secure favorable rates and terms. Continuously monitor payer behavior, identify underperforming contracts, and drive interventions to improve reimbursement, reduce friction, and maximize long-term payer value. Act as the executive partner to Product & Engineering Serve as the RCM leader in product development, shaping the roadmap to embed revenue intelligence directly into the platform. Drive the development of systems like claim scrubbing, eligibility verification, authorization tracking, and documentation validation, ensuring payer requirements are encoded into workflows by default. Design the operating system for scale Build the infrastructure required to support rapid expansion across states and payers. Standardize where possible, introduce automation aggressively, and create systems that can handle increasing volume and complexity without linear increases in headcount. Lead with data and continuous improvement Establish a metrics-driven culture with real-time visibility into revenue performance. Define the KPIs, dashboards, and operating rhythms that enable the organization to diagnose issues quickly, prioritize effectively, and continuously improve revenue capture and speed to cash. 🧠 WHO YOU ARE - 7-10+ years experience in operations with at least 5 years working in commercial payor contracting and revenue cycle operations - Experience applying to and executing payor contracts, ideally with experience successfully negotiating higher reimbursement rates with quick contract turnaround times - Experience running Revenue Cycle Management and building systems with industry leading claims acceptance rates - Previous experience evaluating, onboarding, and managing external vendors/tools - Excellent cross-team collaboration, management skills, and attention to detail - Strong business acumen with the ability to analyze complex revenue, business, and operational data - Experience in the healthcare industry, particularly in pediatric care or related fields We prefer NYC-based candidates (or candidates open to relocation), but are open to remote candidates for this role as well. 🚀 WHY JOIN - Direct exposure to company-building at an early stage. - Real ownership of critical initiatives from day one. - The opportunity to materially impact families and clinicians. - A fast learning curve that few roles can match. COMPENSATION 💵 Competitive salary 📈 Meaningful equity 🏥 Health benefits 🏖️ Flexible PTO 🍱 Dinner when working late