Revenue Cycle Management

About the role

You will own the end to end revenue cycle management operations for Candid Health ensuring that financial processes run smoothly and efficiently across all client portfolios. This role requires you to drive operational excellence in billing denial management prevention reconciliation and payer relations at scale. You will be hands on working alongside billers to solve complex issues and maintain high standards of execution. You will lead enterprise wide initiatives that optimize workflows enhance data transparency and support sustainable growth. In this capacity you will act as a mentor and leader representing Candid Health externally to customers partners and payers. You will set the strategic direction for the RCM function while maintaining a strong focus on tactical execution.

Key facts

What you'll do

• Hire manage and lead high performing onshore and offshore teams responsible for delivering strong revenue cycle operations within billing EDI denial management and payment posting for Candid's portfolio of customers.
• Drive RCM KPIs and outcomes by getting into the details on specific claim level and claim cohort level issues alongside Billers and Billing Leads This position has a high degree of operational and tactical execution.
• Build and scale the department by creating and refining playbooks standardized processes and data management frameworks that support repeatability.
• Oversee customer portfolios by dynamically adjusting resourcing and priorities to ensure high quality service delivery across diverse client needs.
• Monitor key metrics to adjust resourcing and priorities ensuring capacity aligns with fluctuating demand and new customer onboarding requirements.
• Act as the primary point of contact for complex customer issues providing expert consultation and decisive resolutions to maintain client trust in partnership with our Customer Strategy and Operations team.
• Partner closely with Customer Support and Customer Strategy and Operations teams to identify systemic customer issues and implement proactive long term solutions.
• Set strategic direction on scaling the scope of operations for the growing RCM team while balancing quality efficiency and client satisfaction.
• Leverage technology and automation to streamline repetitive tasks reduce manual errors and improve overall throughput within the revenue cycle.
• Collaborate with cross functional stakeholders to align RCM initiatives with broader business objectives and support scalable growth.
• Analyze trends in claim denials and rejections to develop preventive strategies that reduce revenue leakage over time.
• Own the end to end reconciliation process ensuring that payments are posted accurately and disputes are resolved in a timely manner.
• Develop and maintain clear documentation of processes decisions and outcomes to support continuity and enable team scalability.
• Represent Candid Health in external discussions with payers and partners advocating for favorable contract terms and operational agreements.

Requirements

• You have 8-12+ years of medical billing experience including at least 2-3 years of experience building and leading large high performing teams to deliver key business outcomes in complex dynamic environments.
• Experience managing both onshore and offshore teams is preferred and demonstrates your ability to lead distributed operations.
• You have a strong track record of driving revenue outcomes and efficiencies for RCM functions across diverse client portfolios.
• You have strong analytical skills and you possess a learning and investigative mindset that you also value in others on your team.
• You are capable of rolling up your sleeves at an operational and tactical level to drive results alongside your team members on a daily basis.
• You approach RCM preventatively rather than reactively and you have a mindset of using technology to prevent denials and rejections upstream before they impact revenue.
• You have a wide range of experience across multiple specialties multi state billing and telehealth billing scenarios.
• You have experience across a wide range of the revenue cycle including EDI Enrollments Payment Posting and Reconciliation Denial Resolution and Management and other related functions.
• You are a clear and concise communicator who enjoys the challenge of explaining complicated ideas in simple terms both in person and in writing.
• You are motivated by and have a track record of building and maintaining relationships with senior executive customer stakeholders.
• You have experience collaborating with product engineering teams go to market teams customer execution and delivery teams to align on shared goals.
• You understand the importance of compliance and regulatory considerations in medical billing and you ensure that these standards are upheld.
• You are able to manage multiple priorities simultaneously and maintain accuracy under tight deadlines and high volume conditions.
• You demonstrate ownership and accountability for outcomes and you support a culture of continuous improvement within the RCM organization.

Nice to have

• Experience with specific revenue cycle platforms or tools that are common in the industry.
• Familiarity with regulatory changes and compliance updates relevant to medical billing and payer policies.
• Background in managing client relationships in a B2B SaaS or healthcare services environment.

Practical notes

This position is open to all locations within the United States. For metropolitan areas where Candid Health has an office presence New York City San Francisco or Denver the expectation is that this role is in person where our weekly schedule is 4 days in office and 1 day working remotely. For candidates who reside outside of these metropolitan areas this position would be fully remote.

PAY TRANSPARENCY

The estimated starting annual salary range for this position is $150000 to $185000 USD. The listed range is a guideline from Pave https www pave com data and the actual base salary may be modified based on factors including job related skills experience qualifications interview performance market data and so on. Total compensation for this position may also include equity sales incentives for sales roles and employee benefits. Given Candid Health's funding and size we heavily value the potential upside from equity in our compensation package. Further note that Candid Health has minimal hierarchy and titles but has broad ranges of experience represented within roles.