Vice President, Payor Credentialing & Revenue Cycle Management

Job Details:

Job Title: Vice President, Payor Credentialing & Revenue Cycle Management

Location: Remote

Duration: 12+ Months Contract

Department: Revenue Cycle / Administration and Reports To: EVP, Chief Operating Officer (COO)

Position Summary:

The Vice President (VP) of Payor Credentialing and Revenue Cycle Management provides strategic leadership over all aspects of the revenue cycle and credentialing processes. This executive is responsible for ensuring provider credentialing is completed accurately and on time, maximizing reimbursement from third-party payors, and driving financial performance through revenue integrity, compliance, and operational excellence.

Key Responsibilities:

Strategic Leadership & Planning:

Develop and execute a comprehensive revenue cycle strategy aligned with organizational financial goals.

Lead initiatives to improve payer contracting, collections, and reimbursement performance.

Drive integration between credentialing, contracting, and revenue operations to reduce delays and denials.

Payor Credentialing & Enrollment:

Oversee the provider credentialing process for all physicians, mid-levels, and facilities.

Ensure timely and accurate payor enrollment and revalidation to prevent delays in billing and reimbursement.

Maintain compliance with all payor requirements, accreditation standards, and regulatory mandates (e.g., CMS, NCQA, CAQH).

Revenue Cycle Operations:

Oversee the full revenue cycle including patient access, billing, coding, A/R, charge capture, denial management, and collections.

Establish KPIs and reporting structures to monitor performance and outcomes.

Collaborate with IT to enhance the functionality and data integrity of RCM platforms.

Compliance and Risk Management:

Ensure compliance with federal and state laws, payer policies, and healthcare regulations (e.g., HIPAA, CMS, OIG).

Implement internal controls and audit processes to mitigate financial and compliance risks.

Team Development and Leadership:

Lead a large, multi-disciplinary team including directors, managers, credentialing specialists, billers, and coders.

Foster a culture of accountability, excellence, and continuous improvement.

Develop talent and succession planning strategies within the department.

Qualifications:

Bachelor's degree in Healthcare Administration, Business, or related field (Master's degree preferred).

10+ years of progressive leadership experience in healthcare revenue cycle and credentialing.

Deep understanding of payor enrollment, medical billing, coding, reimbursement, and payer contracting.

Demonstrated experience leading large-scale process improvements and change initiatives.

Expertise in revenue cycle KPIs and tools for performance management.

Strong communication, leadership, and strategic planning skills.

Preferred Skills & Certifications:

Certified Revenue Cycle Executive (CRCE) HFMA

CPCS or CPMSM National Association Medical Staff Services (NAMSS)

Familiarity with pay systems and government payor programs (Medicare, Medicaid, Managed Care)