Director of Revenue Cycle Management – Credentialing

🕒 Junho 1

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Heartbeat Health

SiteLinkedInTodas as Vagas

11 - 50 funcionários

⚕️ Seguro de Saúde

📡 Telecomunicações

Healthcare Insurance • Telecommunications

A Heartbeat Health é uma empresa revolucionária de saúde focada em transformar os cuidados cardiovasculares através da cardiologia com abordagem virtual-primeiro. Ao alavancar a conectividade de dispositivos e dados clínicos em tempo real, fornece atendimento cardiovascular acessível e de alta qualidade remotamente, oferecendo serviços como teleconsultas, leituras diagnósticas no mesmo dia e programas de cuidados abrangentes. A Heartbeat Health visa tornar o cuidado da saúde cardíaca mais acessível e eficaz, usando um modelo nacional que permite uma entrega coordenada entre pacientes, cardiologistas e médicos de atenção primária. Eles colaboram com diversos parceiros para criar uma experiência de saúde conectada e contínua, tanto de forma síncrona quanto assíncrona. Sua abordagem simplifica processos de cuidados complexos em etapas gerenciáveis, melhorando os resultados e o engajamento dos pacientes, especialmente em regiões com acesso limitado a cardiologistas.

Descrição

• Own end-to-end accountability for the full revenue cycle, including charge capture, claim submission, denial management, payment posting, AR follow-up, patient billing, and collections. • Manage RCM execution across internal staff and external vendors as appropriate, including SLA oversight, performance management, escalation, and ensuring full visibility into work completed on the organization’s behalf. • Lead continuous improvement of RCM processes and the supporting technology stack, with a focus on financial visibility within clinical workflows and reduction of manual handoffs. • Develop and implement new RCM processes and workflows that improve scalability, reduce manual work, and support consistent execution across internal teams. • Build and maintain reporting and analytics on denial trends, payer performance, AR aging, reimbursement, provider productivity, and collection rates. • Drive initiatives to reduce denial rates, accelerate cash collection, and improve net collection percentage. • Continuously evaluate the optimal mix of internal and external RCM resources and lead the expansion or restructuring of those resources as the organization scales. • Partner with clinical operations, finance, and technology teams to align RCM priorities with broader organizational goals. • Lead and mentor the credentialing function, including direct management of the Credentialing Specialist(s) and any future team growth. • Serve as the organization’s subject matter expert on provider credentialing, payer enrollment, and the connection between credentialing operations and revenue cycle outcomes. • Ensure timely initial credentialing, re-credentialing, and payer enrollment across government and commercial payers in all states of operation. • Optimize credentialing turnaround time and proactively manage payer enrollment timelines to prevent revenue interruption. • Maintain accurate provider records and ensure data integrity between credentialing systems (CAQH, payer portals, internal databases) and billing systems. • Analyze credentialing- and enrollment-related denial trends and implement corrective actions. • Stay current on payer regulations, telehealth credentialing requirements, and licensure rules across all states where the organization operates. • Build the long-term RCM and credentialing roadmap aligned with organizational growth. • Prepare regular reports for the SVP of Clinical Operations and executive leadership on RCM and credentialing performance, risks, and opportunities. • Support audits, compliance reviews, and process improvements across both functions. • Represent RCM and credentialing in cross-functional initiatives, including payer contracting, new market expansion, and new clinical program launches.

🎯 Requisitos

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field required; advanced degree preferred. • 7+ years of progressive experience in healthcare revenue cycle management, including leadership experience. • Demonstrated experience leading both RCM operations and provider credentialing/payer enrollment functions. • Strong background in multi-state, multi-payer environments; telehealth or virtual specialty care experience strongly preferred. • Experience managing RCM operations across internal teams and external vendors, including SLA oversight and performance accountability. • Working knowledge of clearinghouses, EMR billing modules, ERA processing, and end-to-end claims workflows. • Familiarity with specialty care billing workflows, including chronic care management and transitional care management, preferred. • Strong knowledge of government payer enrollment requirements (Medicare, Medicaid, VA, Tricare) and commercial payer enrollment. • Proficiency with credentialing platforms and payer portals (e.g., CAQH). • Excellent analytical skills with the ability to translate RCM and credentialing data into operational insight and executive reporting. • Strong project management skills with the ability to manage multiple workstreams, providers, and payer relationships simultaneously. • Excellent communication skills and the ability to build relationships across clinical, operational, technology, and executive teams. • High attention to detail, accuracy, and ability to meet strict deadlines.

🏖️ Benefícios

• We are mission-driven: we're revolutionizing the way cardiovascular care is delivered • We are fast-paced & agile: we move quickly, iterate often, and value experimentation • We are remote-first: flexibility, autonomy, and trust are at the core of how we operate • We care about diversity: diversity allows us to build an excellent patient experience • We care about each other: we are stronger together through a culture of mutual respect and active support. • We are an equal opportunity employer: we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status