Senior Manager, RCM & Compliance Operations

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.

• 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