Note: The job is a remote job and is open to candidates in USA. Circle Medical is a virtual-first primary care organization delivering technology-enabled healthcare through a digital platform and in-person visits when needed. The Director of Insurance Operations will lead the integrated Revenue Cycle Management and Payor Contracting functions, overseeing clinical revenue from contract negotiation through claims processing, payment posting, denial management, and insurance and self-pay collections. The role will also drive revenue strategy, performance analytics, compliance, and cross-functional operational improvements.
Responsibilities
- Lead the combined Insurance Operations function (Revenue Cycle Management and Payor Contracting) as a single, accountable unit
- Directly manage and develop the RCM management team and the Manager, Payor Contracting, fostering a culture of accountability, transparency, and continuous improvement
- Partner with the Operations, Finance, Legal/Compliance, Product and executive leadership to define short- and long-term revenue strategy aligned to company objectives
- Serve as the single point of accountability for the connection between contract terms and collectability, ensuring what is negotiated is actually operational, and what RCM is seeing informs what gets renegotiated
- Own the end-to-end revenue cycle function, including eligibility, claims integrity, denials, AR follow-up, payment posting, and both insurance and self-pay collections, ensuring operational efficiency and compliance with payor and regulatory standards
- Oversee daily RCM operations for a high-volume, multi-state telehealth first practice, inclusive of the vendor relationship with our claims coding and submission platform
- Own key workflows and process maps for claim submission, follow-up, denials, and appeals; identify and resolve friction points quickly
- Collaborate with Product and Engineering teams to improve automation, EDI connectivity, and billing system integrations
- Oversee negotiation and execution of contracts with healthcare payors, IPAs, and Clinically Integrated Networks, ensuring favorable terms and reimbursement rates
- Partner with clinical leadership to analyze clinical outcomes and develop compelling value propositions for payors that demonstrate the quality of care, ultimately driving improvements in reimbursement rates
- Analyze reimbursement methodologies to identify opportunities for revenue optimization and rate improvement
- Monitor payor performance against KPIs, proactively addressing discrepancies or underperformance in claims processing and payment accuracy
- Maintain strategic, ongoing relationships with payor organizations to support long-term alignment and issue resolution
- Use RCM denial and underpayment data as a direct input into contract renegotiation priorities, closing the loop between what the data shows and what gets renegotiated
- Enhance, track, and report on KPIs across both RCM and payor contracting to identify areas for improvement and drive performance
- Partner with Business Intelligence to develop automated dashboards and monthly reporting packages spanning claims performance and payor economics
- Drive data-driven performance reviews with sub-teams to identify trends, root causes, and opportunities for process improvement
- Serve as the operational liaison between Insurance Operations and Clinical, Telehealth Operations, Patient Support, Legal/Compliance, and Provider Enrollment to ensure documentation, billing, self-pay workflows, and contracting alignment
- Partner with Credentialing and Provider Enrollment to ensure accurate payor setup, EDI enrollment, and fee schedule updates
- Collaborate with Finance on cash forecasting, revenue recognition, and variance analysis tied to both claims performance and contract terms
- Maintain compliance with payor and state telehealth billing and contracting requirements
- Lead initiatives to improve claim accuracy, reduce denials, accelerate cash collections, and improve reimbursement rates
- Proactively identify automation and system enhancement opportunities to improve efficiency and scalability across both functions
Skills
- 8+ years of experience in US healthcare operations with increasing responsibility, including at least 4 years in a leadership role spanning revenue cycle management and/or payor contracting
- Bachelor's or Master's degree in Healthcare Administration, Business, Finance, or a related field
- Demonstrated experience negotiating payor contracts and a working knowledge of reimbursement methodologies
- Deep understanding of healthcare revenue cycle operations, including coding/claims workflows, denial management, and collections
- Experienced, data-driven operator with a track record of building KPIs, dashboards, and performance management frameworks
- Strong communication and stakeholder management skills, with the ability to translate strategy into a clear execution plan across two distinct functions
- Exceptional leadership skills with the ability to inspire teams, build consensus, and influence across functions
- Demonstrated ability to thrive in fast-paced, ambiguous, and rapidly evolving environments
- Applicants must be legally authorized to work in the country where the role is based at the time of application
Benefits
- Benefits vary by country and location of employment; the recruiter will confirm the exact package available during the interview process.
- Paid Time Off: Flexible vacation, sick leave, and 12 statutory holidays.
- Health & Insurance: Medical, Dental, Vision, Disability, and Life insurance.
- Wellness: Mental health programs and an Employee Assistance Program (EAP).
- Retirement: RRSP/401(k) program with company match.
- Development: Annual reimbursement for eligible training and professional programs.
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