Senior Manager, RCM & Compliance Operations
New
United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- 6+ years
- Required Skills
- Microsoft ExcelGoogle Sheets
Requirements
- 6+ years of experience in healthcare revenue cycle management, including hands-on ownership of VOB, claims, and/or credentialing processes.
- Startup or high-growth company experience with comfort operating in fast-paced, ambiguous environments.
- Strong understanding of medical billing workflows, including DME, dental-in-medical, or specialty telehealth models.
- Hands-on expertise with CPT/HCPCS coding, EOB interpretation, payer portals, and reimbursement processes.
- Proven experience partnering with Product or Engineering teams to translate RCM requirements into scalable system functionality.
- Advanced Excel or Google Sheets skills, including pivot tables, lookups, and reporting.
- Strong ability to build SOPs, document workflows, and design operational processes from scratch.
- Excellent analytical and problem-solving skills with a proactive, detail-oriented approach.
- Preferred experience with E0486 and K1027 billing, PC/MSO structures, credentialing systems, and tools such as Candid, Healthie, Canvas, or Athena.
Responsibilities
- Build, structure, and continuously improve verification of benefits (VOB) workflows, including SOPs, QA frameworks, escalation paths, and payer-specific documentation.
- Perform direct VOB execution when needed, including during volume surges, escalated cases, and quality assurance reviews.
- Partner with eligibility and billing vendors to optimize automated workflows and resolve data quality or integration issues.
- Support claims operations by handling payer follow-ups, resolving denials, and identifying root causes to improve upstream processes.
- Translate operational insights into actionable improvements across VOB, credentialing, billing, and product systems.
- Collaborate closely with Product teams to embed RCM logic across the patient lifecycle, from eligibility and prior authorization to claims and AR workflows.
- Support credentialing operations, including CAQH updates, payer applications, and maintenance of SOPs and documentation.
- Assist with multi-state compliance activities, including corporate filings, entity maintenance, and regulatory tracking across telehealth and billing frameworks.
- Build reporting tools and dashboards to analyze VOB performance, claims trends, credentialing status, and operational efficiency.
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