Revenue Cycle Management / RCM Leader

Job description

About the Role The Revenue Cycle Management (RCM) Lead is a senior leader responsible for overseeing the full spectrum of revenue cycle operations across Candid Health's portfolio of clients. This role drives enterprise-wide financial performance, and operational excellence in billing, denial management & prevention, reconciliation, and payer relations. This senior leader is responsible for day-to-day management of the Candid RCM team, including being hands-on alongside billers. This person will also own cross-functional initiatives to optimize revenue cycle workflows, enhance data transparency, and support scalable growth aligned with Candid Health’s evolving business needs. This role will also represent Candid Health externally with customers, partners, payers, and internally as a mentor and leader of high-performing teams. What You’ll Be Doing - Hire, manage and lead high-performing onshore and offshore teams, responsible for delivering strong revenue cycle operations within billing, EDI, denial management, and payment posting for Candid’s portfolio of customers. - Drive RCM KPIs and outcomes by getting into the details on specific claim-level and claim cohort level issues alongside Billers and Billing Leads (This position has a high degree of operational and tactical execution). - Build & scale the department by creating and refining playbooks, standardized processes, and data management frameworks. - Oversee customer portfolios by dynamically adjusting resourcing and priorities to ensure high-quality service delivery. - Monitor key metrics to adjust resourcing and priorities, ensuring capacity aligns with fluctuating demand and new customer onboarding. - Act as the primary point of contact for complex customer issues, providing expert consultation and decisive resolutions to maintain client trust in partnership with our Customer Strategy & Operations team. - Partner closely with Customer Support and Customer Strategy & Operations teams to identify systemic customer issues and implement proactive long-term solutions. - Set strategic direction on scaling the scope of operations for the growing RCM team. Who You Are - You have 8-12+ years of medical billing experience, including at least 2-3 years of experience building and leading large, high-performing teams to deliver key business outcomes in complex, dynamic environments. - Experience managing both onshore and offshore teams is preferred - You have a strong track record of driving revenue outcomes & efficiencies for RCM functions - You have strong analytical skills - you have a learning and investigative mindset and value those mindsets in others. - You are capable of rolling up your sleeves at an operational and tactical level to drive results alongside your team. - You approach RCM preventatively vs reactively - you have a mindset of using technology to prevent denials/rejections upstream. - You have a wide range of experience across multiple specialties, multi-state billing, and telehealth billing. - You have experience across a wide range of the revenue cycle: EDI Enrollments, Payment Posting and Reconciliation, Denial Resolution and Management, etc. - You are a clear and concise communicator; you enjoy the challenge of explaining complicated ideas in simple terms, both in-person and in writing. - You are motivated by and have a track record of building and maintaining relationships with senior executive customer stakeholders. - Experience collaborating with product/engineering teams, go to market teams, customer execution and delivery teams. Location This position is open to all locations within the United States. For metropolitan areas where Candid Health has an office presence (New York City, San Francisco, or Denver) the expectation is that this role is in-person where our weekly schedule is 4 days in-office and 1 day working remotely. For candidates who reside outside of these metropolitan areas this position would be fully remote. PAY TRANSPARENCY The estimated starting annual salary range for this position is $150,000 to $185,000 USD. The listed range is a guideline from Pave https://www.pave.com/ data, and the actual base salary may be modified based on factors including job-related skills, experience/qualifications, interview performance, market data, etc. Total compensation for this position may also include equity, sales incentives (for sales roles), and employee benefits. Given Candid Health’s funding and size, we heavily value the potential upside from equity in our compensation package. Further note that Candid Health has minimal hierarchy and titles, but has broad ranges of experience represented within roles.