Senior Vice President of Eligibility, Claims and Revenue Management

Progyny, Inc.-posted 3 months ago
$280,000 - $300,000/Yr
Full-time • Senior
New York, NY
501-1,000 employees
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Progyny is seeking a strategic and operationally strong Senior Vice President of Eligibility, Claims and Revenue Management to lead and optimize our eligibility and claims functions as well as revenue cycle management. This executive role is critical to ensuring the accuracy, efficiency, and scalability of our core operational processes that directly impact revenue recognition, customer satisfaction, and compliance. The ideal candidate will bring deep healthcare operations experience, strong technical acumen, and a collaborative leadership style to drive continuous improvement across eligibility data management and outsourced claims processing. This role reports directly to the Chief Operating Officer (COO) and is responsible for leading a team across claims management, eligibility, carrier and member revenue operations, billing, and cash conversion functions. The ideal candidate is a strategic thinker and hands-on leader with a proven ability to drive operational excellence, optimize performance, and foster a high-performing team culture.

  • Lead, mentor, and develop a team of 40+ individuals across multiple functions.
  • Establish clear goals, accountability structures, and professional development pathways.
  • Promote a culture of collaboration, ownership, and continuous improvement.
  • Lead the end-to-end eligibility function, including data validation, exception resolution, and reporting.
  • Ensure accurate onboarding and billing of customers, carriers, and members through robust eligibility processes.
  • Partner with Client Success and Implementation teams to ensure receipt and integration of standard eligibility file formats.
  • Manage exceptions where custom file formats are required, with a long-term strategy to migrate to standard formats.
  • Develop and maintain dashboards and KPIs to monitor eligibility data quality and operational performance.
  • Provide strategic oversight of outsourced claims processing partners.
  • Map and document current claims workflows and identify opportunities for automation and process optimization.
  • Establish and enforce best practices in claims adjudication, auditing, and reporting.
  • Collaborate with Finance and Compliance to ensure claims processes align with regulatory and revenue recognition requirements.
  • Oversee all carrier revenue operations including claims processing and billing options.
  • Manage member revenue operations including claims, reimbursement activities, and payment workflows.
  • Ensure compliance with payer contracts, regulatory requirements, and internal policies.
  • Drive system enhancements and process automation to support scalable operations.
  • Define and monitor KPIs across all revenue cycle functions.
  • Identify and implement optimization strategies to improve efficiency, accuracy, and financial outcomes.
  • Ensure timely and accurate cash conversion across all billing activities.
  • Serve as a key liaison between Operations, Technology, Client Success, Implementation, and Finance teams.
  • Drive cross-functional initiatives that improve data integrity, operational efficiency, and customer experience.
  • Lead and mentor a high-performing team, fostering a culture of accountability, innovation, and continuous improvement.
  • Bachelor’s degree in Business, Finance, Healthcare Administration, or related field (Master’s preferred).
  • 15+ years of experience in revenue cycle management, with at least 5 years in a senior leadership role.
  • Demonstrated success in managing and developing large teams (20+ individuals).
  • Strong understanding of healthcare claims processing, reimbursement methodologies, and payer relations.
  • Proven track record of driving operational excellence and process optimization.
  • Exceptional analytical, communication, and leadership skills.
  • Proficiency with revenue cycle technologies and platforms.
  • Experience in fertility benefits or specialized healthcare services.
  • Lean Six Sigma or similar process improvement certification.
  • Familiarity with value-based care or alternative payment models.
  • Strong interpersonal skills, ability to work independently and collaboratively within a team environment.
  • Ability to effectively manage evolving priorities, multiple projects, and deadlines in a fast-paced environment.
  • Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents’ Employee Affiliation Group.
  • Menopause and midlife care.
  • Health, dental, vision and life insurance options for employees and family.
  • Free in-person, virtual and text-based mental health and wellness support.
  • Paid time off, including vacation, sick leave, personal days and summer flex time.
  • Company equity.
  • Bonus program.
  • 401(k) plan with company match.
  • Access to on-demand legal and financial advice.
  • Learning and development programs to help you grow professionally and a mentorship program.
  • Company social events to include annual volunteer day and donation matching.
  • Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office.
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