Director Insurance, RCM Insurance Operations Support

About the Role: 

The Director of RCM Insurance Operations Support provides strategic and operational leadership for insurance-related revenue cycle functions, with a strong focus on denial management, high-dollar and aged account resolution, and process excellence. This role partners cross-functionally with Client Success (CS), Product/ Analytics, IT, and Operational managers to drive revenue integrity, reduce avoidable denials, and ensure scalable, best-in-class operating practices.

This leader manages advanced operational analytics, user acceptance testing (UAT) superuser, workflow optimization, and continuous improvement initiatives that enhance reimbursement, operational efficiencies, compliance, and overall financial performance.

Key Responsibilities:  

​​Denial Management & High-Dollar Account Strategy 

• ​Lead enterprise-wide denial prevention and resolution strategy, including root cause analysis and corrective action planning 

• ​Oversee prioritization, management, and escalation of high-dollar accounts and complex claims to accelerate cash recovery 

• ​Architect trending reports and dashboards to identify systemic issues across payers, service lines, and workflows 

• ​Partner with Client Success to deliver insights to clients, helping them understand and respond to payer behavior and policy changes 
• ​Consult on denial avoidance strategies regarding front-end, mid-cycle, and back-end processes 

​Analytics & Performance Improvement 

• ​Architect and lead advanced denial analytics and performance reporting to drive actionable insights 

• ​Manage KPIs for denial rates, overturn rates, AR days (insurance), high-dollar aging, and cash acceleration 

• ​Conduct ongoing root cause analysis across Denials, High Dollar, and Complex Claims 

• ​Partner with Client Success to produce executive-level reporting and performance reviews to support data-driven decision-making 

• ​Identify and implement system-driven automation opportunities to improve efficiency and accuracy 

​ Operational Excellence & Best Practices 

• ​Establish and enforce standardized workflows aligned with industry best practices in revenue cycle operations 

• ​Lead continuous improvement initiatives, including Lean/Six Sigma methodologies where applicable 

• ​Drive standardization across teams for denial workflows, appeals processes, and account resolution 

• ​Ensure compliance with payer requirements, CMS regulations, and internal policies 

• ​Promote a culture of accountability, transparency, and performance excellence 

​Cross-Functional Leadership 

• Partner with Client Success, Finance, Operations Mgrs, Coding, IT, and Product teams to address drivers and opportunities of denials 

• Collaborate with training and education teams to develop targeted learning programs based on denial trends 

• Support organizational initiatives including value-based care, risk contracts, and regulatory readiness 

Team Leadership & Development 

• Build, mentor, and lead high-performing teams supporting insurance operations functions 

• Establish clear expectations, performance goals, and professional development pathways 

• Foster a collaborative, solutions-oriented environment focused on continuous improvement 

 Required Qualifications:  

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field 

• 8–10+ years of progressive leadership experience in healthcare Revenue Cycle Management 

• Deep expertise in insurance operations, denial management, and payer reimbursement processes 

• Proven experience managing high-dollar AR and complex accounts 

• Demonstrated success leading UAT and system implementations (e.g., Epic, Cerner, Meditech) 

• Strong analytical and problem-solving capabilities with experience in data-driven decision-making 

Core Competencies:  

• Strategic Thinking & Execution 

• Financial Acumen & Revenue Optimization 

• Data Analytics & Insights 

• Change Management 

• Cross-Functional Collaboration 

• Process Improvement & Standardization 

• Leadership & Team Development 

Preferred Qualifications:  

• Master’s degree (MBA, MHA, or related field)  

• Certification in HFMA, Lean Six Sigma, or revenue cycle discipline  

• Experience in multi-site or large health system environments  

• Advanced knowledge of automation tools, RPA, or AI-driven revenue cycle solutions 

Physical & Work Requirements:  

• Employees are expected to maintain a professional appearance and always conduct themselves in a professional manner 

• Work is performed indoors in an office setting, requiring sustained periods of sitting and/or standing while operating a computer 

• Demonstrates physical and functional ability to perform full anatomical range of motion to accomplish tasks 

• Ability to lift XX pounds 

• Effective communication skills are required for interaction in person and via telephone 

Employment eligibility:  

Must be legally authorized to work in the United States without sponsorship 

As a condition of employment, a pre-employment background check will be conducted