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Circle Medical is a virtual-first primary care organization reimagining healthcare delivery through technology and human connection. This newly created Director role owns the full financial lifecycle of clinical revenue, unifying historically separate functions: Revenue Cycle Management (RCM), Payor Contracting, and self-pay revenue oversight.
Reporting to the VP of Operations, you will lead end-to-end accountability for all clinical revenue operations across a high-volume, multi-state telehealth practice. Key responsibilities include:
**Leadership & Strategy**: Manage and develop the RCM management team and Manager of Payor Contracting. Define short- and long-term revenue strategy aligned to company objectives. Serve as the single point of accountability connecting contract terms to operational collectability—ensuring negotiated terms are executable and RCM insights inform renegotiation priorities.
**Revenue Cycle Operations**: Own eligibility, claims integrity, denials, AR follow-up, payment posting, and insurance/self-pay collections. Oversee daily RCM operations and vendor relationships with claims coding/submission platforms. Optimize workflows for claim submission, follow-up, denials, and appeals. Collaborate with Product and Engineering to improve automation, EDI connectivity, and billing system integrations.
**Payor Contracting & Relations**: Negotiate and execute contracts with healthcare payors, IPAs, and Clinically Integrated Networks. Partner with clinical leadership to develop value propositions demonstrating care quality and driving reimbursement rate improvements. Analyze reimbursement methodologies for revenue optimization. Monitor payor performance against KPIs and maintain strategic relationships. Use denial and underpayment data to inform contract renegotiation priorities.
**Analytics & Performance Management**: Enhance and track KPIs across RCM and payor contracting. Partner with Business Intelligence to develop automated dashboards and monthly reporting. Drive data-driven performance reviews to identify trends, root causes, and improvement opportunities.
**Cross-Functional Collaboration**: Serve as operational liaison between Insurance Operations and Clinical, Telehealth Operations, Patient Support, Legal/Compliance, and Provider Enrollment. Partner with Credentialing and Provider Enrollment on payor setup and EDI enrollment. Collaborate with Finance on cash forecasting and revenue recognition.
**Compliance & Continuous Improvement**: Maintain compliance with payor and state telehealth billing requirements. Lead initiatives to improve claim accuracy, reduce denials, accelerate collections, and improve reimbursement rates. Identify automation and system enhancement opportunities.
Required: 8+ years US healthcare operations experience with increasing responsibility, including 4+ years in leadership spanning RCM and/or payor contracting. Bachelor's or Master's degree in Healthcare Administration, Business, Finance, or related field. Demonstrated payor contract negotiation experience and working knowledge of reimbursement methodologies. Deep understanding of healthcare revenue cycle operations including coding, claims workflows, denial management, and collections.
