Senior Manager, RCM & Compliance Operations at Jobgether

, , United States -

Full Time

Start Date

Immediate

Expiry Date

02 Oct, 26

Salary

0.0

Posted On

04 Jul, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Revenue Cycle Management, Verification Of Benefits, Claims Execution, Medical Billing, Regulatory Compliance, Credentialing, CPT/HCPCS Coding, EOB Interpretation, SOP Development, Data Analysis, Product Partnership, Network Management

Industry

Internet Marketplace Platforms

Description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Manager, RCM & Compliance Operations based in United States. This role sits at the core of healthcare operations, bridging revenue cycle management, payer workflows, and multi-state regulatory compliance within a fast-evolving telehealth environment. The Senior Manager will operate as both a builder and hands-on operator, strengthening verification of benefits processes, supporting claims execution, and ensuring accuracy across billing and reimbursement workflows. This position plays a critical role in translating complex RCM requirements into scalable systems and product functionality in close partnership with cross-functional teams. You will also contribute to credentialing, network management, and compliance operations across a distributed provider ecosystem. The role requires someone comfortable navigating both strategic design discussions and detailed operational execution. It is ideal for a highly autonomous operator who thrives in ambiguity and wants to grow into a broader leadership scope. \n Accountabilities: 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. 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. Benefits: Competitive compensation package aligned with experience Health, dental, and vision insurance coverage Opportunity to work in a high-growth telehealth environment transforming sleep medicine delivery Flexible work environment supporting autonomy and ownership Exposure to cutting-edge RCM systems, AI-enabled diagnostics, and modern healthcare infrastructure Opportunity to work closely with cross-functional Product, Clinical, and Compliance teams \n How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1

Responsibilities

The Senior Manager will build and optimize verification of benefits and claims workflows while ensuring multi-state regulatory compliance. They will collaborate with product teams to translate RCM requirements into scalable system functionality within a telehealth environment.