Credence Resource Management - Vice President - Healthcare RCM Operations

Key Responsibilities:

Strategic Leadership & Governance:

- Provide strategic direction and long-term vision for Healthcare RCM operations

- Own operational P&L, margins, productivity metrics, and cost optimization initiatives

- Drive standardization, best practices, and continuous improvement across RCM processes

- Partner with executive leadership on growth strategy, capacity planning, and expansion

Compliance, Risk & Quality:

- Ensure compliance with HIPAA, HITECH, CMS regulations, and payer guidelines

- Oversee internal and external audits and corrective action plans

- Implement strong data security, access controls, and governance frameworks

- Own quality assurance frameworks and continuous quality improvement programs

Financial & Performance Management:

- Track and improve KPIs including AR days, first-pass yield, denial rates, productivity, and cost per claim

- Manage budgets, forecasting, and resource utilization

- Drive revenue growth through operational efficiencies and upsell opportunities

Required Skills & Qualifications:

Experience & Education:

- 10+ years of experience in Healthcare Revenue Cycle Management operations

- Proven experience managing large-scale offshore RCM delivery for US healthcare clients

- Bachelor's degree in Healthcare Administration, Business, Life Sciences, or related field

- Master's degree (MBA / MHA) preferred

Core Leadership & Business Skills:

- Strong strategic thinking and decision-making abilities

- Deep understanding of US healthcare reimbursement models

- Excellent client-facing, communication, and executive presentation skills

- Proven ability to manage P&L and drive operational profitability

- Strong change management and transformation leadership

Technical & Domain Skills:

- Healthcare RCM Expertise

- In-depth knowledge of US healthcare RCM workflows and payer rules

- Strong understanding of Medicare, Medicaid, and Commercial payer processes

- Expertise in denial prevention, root cause analysis, and recovery strategies

Technology & Analytics:

- Experience with leading RCM platforms (Epic, Cerner, Athena, eClinicalWorks, Meditech, NextGen, etc.)

- Exposure to RPA, AI, and analytics-driven RCM transformation

- Strong command of MIS, dashboards, and operational reporting

Compliance & Quality:

- Expert-level understanding of HIPAA, PHI handling, and data security

- Experience managing audits, SOC, and compliance frameworks

- Strong QA governance and risk mitigation capabilities

Key Performance Indicators (KPIs):

- Reduction in AR days and denial rates

- Improvement in cash collections and first-pass yield

- SLA adherence and quality scores

- Client satisfaction and retention

- Margin improvement and cost optimization