Associate Director, Billing Strategy (Healthcare RCM)

TL;DR

Associate Director, Billing Strategy (Healthcare RCM): Leading the strategy and optimization of denied claims and appeals to improve reimbursement outcomes with an accent on root cause analysis and payer advocacy. Focus on translating operational expertise into system logic and driving automation initiatives across denial workflows.

Location: Remote (US)

Company

hirify.global is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women's health, and organ health.

What you will do

• Lead denial management and appeals strategy across all payer types, tracking overturn rates and recovery performance.
• Manage the performance of outsourced RCM teams and ensure accountability through data-driven audits.
• Perform root cause analysis to identify denial trends and distinguish between operational and systemic challenges.
• Translate operational workflows into system logic to support automation initiatives like rules engines and RPA.
• Define requirements for denial routing and appeal triggers, leading UAT and QA for system changes.
• Analyze large datasets using Power BI, SQL, and Snowflake to quantify financial impact.

Requirements

• 8–12+ years of experience in healthcare Revenue Cycle Management (RCM) with a deep focus on denials and appeals.
• Expertise in laboratory billing, CPT coding, and reimbursement methodologies.
• Strong knowledge of commercial, Medicare, Medicaid, and managed care payer policies.
• Proven success in improving appeal overturn rates and managing BPO/offshore vendors.
• Strong analytical proficiency with Power BI, Excel, SQL, or Snowflake.
• Must be based in the US

Nice to have

• Experience supporting RPA or workflow automation tools in a revenue cycle context.
• Familiarity with AI-driven workflow concepts like intelligent routing and decisioning.
• Experience with AMD billing platforms or Jira for workflow tracking.

Culture & Benefits

• Comprehensive medical, dental, vision, life, and disability plans for employees and dependents.
• Free genetic testing and fertility care benefits for employees and their immediate families.
• 401k and commuter benefits.
• Pregnancy and baby bonding leave.
• Opportunity to work with elite industry professionals in a mission-driven environment.