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