Head of Revenue Cycle Management

Description Head of Revenue Cycle Management Description Job Description: Head of Revenue Cycle Management (RCM) Role: Head of RCM Industry: Healthcare (Multi-Specialty: Podiatry, Vascular/Vein, & OBL) Location: Remote Reports to: Director of Finance Executive Summary We are seeking a strategic, data-driven Head of Revenue Cycle Management to oversee the end-to-end financial health of our expanding multi-specialty practice. This is a rare opportunity to build the revenue cycle function of a national, multi-specialty healthcare organization (Podiatry, Vascular Surgery & Interventional Radiology) from the ground up - with the resources of a well-capitalized parent company and the autonomy of a lean, entrepreneurial team. The Head of RCM will have direct visibility to executive leadership, meaningful influence over platform acquisitions, and the opportunity to architect systems that scale across a growing portfolio of specialty practices. The ideal candidate is a "builder" who can scale processes, optimize clean claim rates, and navigate the specific regulatory landscapes of surgical and interventional outpatient care. Core Responsibilities 1. Strategic Leadership & Scaling Design, implement, and continuously improve end-to-end RCM workflows across all specialty platforms, ensuring consistency while preserving the clinical and billing nuances of each service line. Define and monitor an org-level KPI dashboard covering First Pass Rate, Net Collection Rate, Denial Rate, Days in A/R, Clean Claim Rate, and Prior Auth approval rates. Evaluate, select, and manage third-party billing vendors where applicable; define SLAs, hold vendors accountable, and determine in-source/outsource strategy as the organization scales. Build and lead the internal RCM team - hiring, training, and developing billing staff, coders, and AR specialists across subsidiaries. Report regularly to the Director of Finance and C-Suite on revenue cycle performance, translating billing data into executive-level narratives with clear recommendations. 2. Specialized Revenue Oversight OBL & Vascular/IR: Ensure precise capture of high-cost implantable supplies and complex interventional coding (C-arm procedures, atherectomies, thrombectomies, dialysis access, MSK Embolization). Manage facility and professional fee splits. Stay current on CMS Local Coverage Determinations (LCDs) for vascular procedures. Podiatry: Optimize high-volume claims processing, including CPT coding accuracy, DME (Durable Medical Equipment) billing, routine vs. non-routine care distinctions, and multi-provider practice management. Payer Relations: Lead payor contract negotiations across all subsidiaries to ensure optimal reimbursement rates for specialized procedures. Maintain a comprehensive payer contract library and monitor for mid-year policy changes. 3. Front-End & Middle-Cycle Excellence Oversee prior authorization processes - particularly for vein/vascular procedures and OBL surgeries - implementing systems that minimize preventable denials before claims are submitted. Implement robust patient eligibility verification at the point of scheduling and registration. Collaborate with clinical staff and EMR administrators to improve documentation quality, coding accuracy, and charge capture timeliness. Oversee charge posting, payment posting, and AR appeals workflows; serve as the escalation point for complex billing disputes. 4. Compliance & Technology Ensure 100% compliance with HIPAA, CMS Conditions for Coverage, OIG guidelines, Medicare and Medicaid regulations, and commercial payer policy requirements. Maintain and update internal billing policies and procedures in response to regulatory changes; communicate updates to clinical and administrative teams. Conduct regular internal audits of claim accuracy, coding appropriateness, and documentation completeness. Monitor federal and state legislative changes affecting reimbursement, implement required workflow adjustments, and brief executive leadership on material impacts. 5. Technology, Data & Analytics Evaluate, implement, and optimize RCM technology platforms - including Practice Management (PM) systems, EHR integrations, clearinghouses, and AI-enabled claims adjudication tools. Develop and maintain dashboards and reporting infrastructure that provide real-time visibility into revenue cycle performance at the platform and BSO levels. Drive automation of manual billing tasks to improve throughput and reduce human error. Leverage data analytics to identify denial patterns, underpayment trends, and revenue leakage - and implement corrective action plans. Requirements Candidate Requirements Experience: 7+ years in Healthcare RCM leadership. Direct experience with OBL (Office-Based Lab) or ASC (Ambulatory Surgery Center) billing is highly preferred. Knowledge: Deep understanding of Podiatry, Vascular/interventional radiology coding and medical necessity requirements. Analytical Skills: Advanced proficiency in Excel/BI tools; ability to "tell the story" behind the numbers to the executive board. Education: Bachelor’s degree in Healthcare Administration, Finance, or related field. MBA or MHA is a plus. Certifications: CPC, COC, or CHFP preferred. Compensation: $165,000 - $175,000 base salary, with the ability to go above range for candidates with exceptional experience and proven impact. #J-18808-Ljbffr Sorispainvascular