RCM Operations Lead

Prosper Health•New York, NY

3d•Hybrid

About The Position

Prosper Health is seeking an RCM Operations Lead to manage the day-to-day operations of their revenue cycle management. This role is crucial for collecting payments accurately and efficiently, which funds the company's clinical mission. The RCM Operations Lead will oversee claim management, vendor relationships, manage an offshore RCM team, handle internal billing inquiries, and manage payer relationships across different states. This is a high-ownership role requiring someone who can move fast, prioritize effectively, and investigate issues thoroughly.

Requirements

5+ years of hands-on RCM experience.
Strong familiarity across the claims lifecycle: denials, rejections, adjustments, resubmissions.
Comfortable in Availity and standard provider portals.
Ownership-oriented: keep workflows clean, follow up on open items without being asked, and treat the function as your own.
Clear communicator: surface important information in an actionable format and remain responsive.
Comfortable in a fast-moving environment; startup or high-growth experience preferred.
Ability to manage multiple workstreams simultaneously and stay organized with minimal oversight.
Willingness to push back, flag problems, and hold vendors and internal teams to a higher standard, even without formal authority.

Responsibilities

Own end-to-end billing operations across the full claims lifecycle, including insurance verification, prior authorization, claim submission, follow-up, denial/rejection resolution, and back-end reporting.
Lead and manage a team of 4+ offshore support staff, setting priorities, assigning workstreams, reviewing output, and ensuring consistency and accuracy.
Serve as the escalation point for issues arising within the RCM team and ensure processes are running correctly.
Manage a high volume of billing questions and escalations from vendors and internal teams, investigating patient responsibility questions, handling vendor escalations, and triaging high-priority items like medical record subpoenas and collection agency contacts.
Support ad-hoc RCM projects, including state launches, new payer setup, provider enrollment, and credentialing gaps for existing clinicians.