Director, Revenue Cycle Management

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SimpliFed

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2020

💼 Consulting

🍽️ Food & Beverage

✈️ Travel

💰 Non Equity Assistance - SimpliFed on 2025-03

Consulting • Food & Beverage • Travel

SimpliFed is a digital maternal and infant-care platform that delivers tailored lactation, baby-feeding, and postpartum support for families while integrating with providers and health plans. The company provides virtual care and coordinated care pathways (referrals, EHR/EMR integration, automated workflows) to improve feeding outcomes, reduce ER utilization, and support clinical quality measures. SimpliFed serves families directly and partners with health systems and payers to embed scalable, outcomes-focused maternal health services.

📋 Description

• Own the end-to-end revenue cycle, including eligibility and benefits verification, charge capture, coding, claim submission, denial management, appeals, AR follow-up, patient billing, and cash posting • Own configuration of Candid Health, including payer rules, fee schedules, and claim edits • Establish monitoring cadence and modify billing rules based on data • Lead the revenue cycle workstream for the Healthie EHR implementation • Ensure clinical documentation, encounter data, and charge flow map correctly into billing • Manage cleanup and resolution of legacy claims from the prior system • Establish and maintain a single source of truth for payer, plan, provider, and contract data • Build revenue cycle reporting, including cash forecasts, AR aging, denial trends, and yield by service line • Own revenue cycle metrics and explanations • Manage payer escalations, underpayments, and payer performance • Partner with credentialing and payer enrollment teams to maintain a current, billable provider roster • Lead, support, and develop a small RCM team, including the existing RCM Manager • Assess the current state, identify revenue leakage, and produce a prioritized remediation plan • Improve clean claim rate, first-pass yield, denial rate, days in AR, and net collection rate

🎯 Requirements

• 7+ years in healthcare revenue cycle experience • 3+ years leading a team or function • Deep professional physician/practitioner billing experience, not solely facility/hospital billing • Hands-on ownership of a modern billing or claims platform; Candid Health strongly preferred, with Waystar, Availity, Office Ally, Change/Optum, or similar considered • Demonstrated revenue-cycle experience through an EHR implementation or migration • Fluency with CPT, HCPCS, ICD-10, modifiers, and payer-specific billing requirements • Track record of reducing denials and days in AR, with evidence to demonstrate results • Ability to reconcile and validate messy data and build structure where none exists • Direct experience managing commercial payer escalations, underpayments, and performance issues • Telehealth, virtual care, or digital health billing experience preferred • Familiarity with preventive services and ACA-mandated coverage, including lactation and maternal health benefits preferred • Healthie experience preferred • SQL, BI tools, or advanced spreadsheet modeling preferred • Startup or small-company experience preferred • Ability to work remotely and communicate asynchronously via Slack and email and participate effectively in virtual meetings • Ability to work in a fast-paced, team environment • Valid driver's license and REAL ID • Currently authorized to work full-time in the United States

🏖️ Benefits

• Unlimited PTO plus company holidays • 401(k) eligibility • Remote-first work with flexibility • Real scope and autonomy • Direct access to leadership • Mandate to change how things are done • Opportunity to build the revenue cycle function from the ground up