Director of Revenue Cycle Management & Credentialing

About the Role

We are a nationwide virtual cardiology organization seeking a Director of Revenue Cycle Management & Credentialing to lead and continuously improve the revenue cycle and credentialing functions that power our growing multi-state provider network. This role owns end-to-end accountability for the full revenue cycle and oversees provider credentialing and payer enrollment across government and commercial payers. The Director will lead RCM operations across internal teams and external partners, lead the credentialing team, and serve as the owner of RCM and credentialing performance, reporting, and continuous improvement. This is a high-impact role responsible for ensuring strong financial outcomes, payer enrollment integrity, and operational visibility as the organization scales claims volume in a multi-state, multi-payer specialty care environment. The Director reports to the SVP of Clinical Operations.

Key Responsibilities

Revenue Cycle Management

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.

Credentialing & Payer Enrollment

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.

Strategic & Cross-Functional Leadership

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.

About You

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.