Job Description

ABOUT THE ROLE

We are seeking a highly capable operator to build and lead Revenue Cycle Management at Daymark. You will own the end-to-end revenue cycle function, including professional billing, third-party billing vendor management, claims operations, and risk adjustment, while partnering closely with Clinical Operations, Finance, Product, and Data.

The right candidate brings deep technical fluency in billing and claims processing end to end, hands-on experience managing billing vendors and clearinghouse platforms, and a forward-thinking orientation toward AI-enabled RCM. This role is ideal for someone who wants to build a function from the ground up and grow with it.

WHAT YOU’LL DO

Own Daymark's Revenue Cycle Operations

• Lead end-to-end RCM across all payer types, with primary focus on Original Medicare and value-based contract populations
• Establish patient billing workflows including statement generation, cost-sharing communication, and collections processes; ensure workflows are sensitive to the patient experience while maintaining collection integrity
• Manage the third-party billing vendor relationship, including performance monitoring, issue escalation, contract compliance, and ongoing optimization
• Own the claims and clearinghouse platform, including submission workflows, rejection and denial management, and resubmission processes
• Establish and track RCM KPIs: clean claim rate, denial rate, days in AR, net collection rate, and others
• Partner with Finance on revenue recognition, cash flow forecasting, and month-end close support

Risk Adjustment

• Support accurate risk adjustment operations aligned with our care model and payer contracts
• Partner with Clinical Operations, Product and Data to ensure risk adjustment workflows are reflected in tooling and supported from pre-chart prep to documentation and through billing and claim submission

Credentialing

• Support end-to-end enrollment workflows for new providers, including NPI registration, CAQH profile maintenance, and payer-specific credentialing applications
• Track credentialing status and expiration timelines across the provider panel to ensure no gaps in billing eligibility
• Partner with Clinical Operations and People to build onboarding workflows that sequence credentialing milestones with provider start dates
• Identify and manage credentialing vendors or delegated credentialing arrangements where applicable

AI and Technology in RCM

• Identify and evaluate AI-enabled tools across the RCM workflow, including automated coding assistance, denial prediction, and other capabilities
• Partner with Product and Data to pilot and implement capabilities that improve throughput and accuracy

Operational Infrastructure

• Translate billing and compliance requirements into scalable operational workflows
• Establish audit and QA processes to ensure coding accuracy and billing integrity
• Identify execution gaps and drive resolution across cross-functional teams

WHAT WE ARE LOOKING FOR

Experience

• Direct experience managing a third-party billing vendor and a claims/clearinghouse platform
• Experience with HCC coding, risk adjustment suspecting, and chart review workflows
• Familiarity with AI applications in RCM and a genuine interest in applying them
• Experience at a startup or high-growth healthcare company is a plus

Qualities

• You are both strategic and highly execution-oriented; you can design the system and work within it
• You bring strong analytical instincts and are comfortable working with billing data directly
• You can partner effectively across clinical, operational, finance, and technical teams
• You are energized by building from scratch
• You have high standards for compliance and billing integrity

ADDITIONAL INFORMATION

This role is fully remote, but will be expected to work on either Eastern or Central time zone hours. We are unable to sponsor work visas for this role.

Compensation: $120,000 - $135,000 annually, depending on location & experience.