Vice President of Operations - Healthcare

Humareso•Canonsburg, PA

About The Position

The Vice President of Operations leads the company's healthcare operations and service delivery across Revenue Cycle Management (RCM), Medical Software Management (MSM), and Population Health Management (PHM). The role is the operational authority for private-practice management, spanning physician clinical workflows, front-desk registration, and billing and payment processes. It oversees physician transitions from corporate or hospital-based employment into independent practice, including credentialing, payer enrollment, EHR selection and implementation, billing setup, staffing, compliance, and operational launch. The position directs billing and revenue-cycle operations; establishes coding, compliance, quality-control, and financial performance standards; and oversees EHR support, population-health services, and a distributed workforce. It is responsible for building documented operating procedures, establishing the company's operating cadence and accountability systems, guiding cloud and AI-enabled workflow development, and owning the operating P&L, budget, and client-level profitability analysis.

Requirements

At least 10 years of progressive experience in private-practice healthcare operations, revenue-cycle management, physician-practice management, or health information technology; hospital administration does not meet this requirement.
At least 5 years in a senior operational leadership role directly managing a team of 15 or more people in a healthcare services environment.
Deep billing expertise, including CPT, ICD-10, HCPCS, modifier coding, denial management, payer appeals, EOB and ERA reconciliation, clearinghouse operations, and Medicare/Medicaid billing requirements.
Demonstrated P&L ownership, including direct budget accountability, forecasting, and financial management in a services business.
Hands-on experience with at least two EHR platforms, such as Medent, eClinicalWorks, NextGen, ModMed, athenahealth, Micro MD, AdvancedMD, or equivalent platforms.
Documented experience leading geographically distributed teams with structured accountability, output metrics, and communication systems.
Proficiency with Microsoft 365, including Teams, SharePoint, OneDrive, Excel, Outlook, and Word, as daily operational tools.
Experience building operational manuals, training curricula, and workflow documentation from scratch.
Experience supporting physicians moving from employment or hospital-based practice into independent practice, including payer enrollment, credentialing, EHR selection, and operational launch.
Working knowledge of value-based care models, quality incentive programs, and chronic-care-management billing.

Nice To Haves

Active membership in an organization; the specific organization is not stated in the posting.
Familiarity with the Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials.
Experience with the No Surprises Act and Independent Dispute Resolution process.
Familiarity with Remote Patient Monitoring and Remote Therapeutic Monitoring billing under 2024–2026 CMS guidelines.
Familiarity with selecting, implementing, or integrating ambient AI documentation tools.
Prior experience at a company with revenue between $3 million and $15 million.
MBA, MHA, or equivalent graduate degree.

Responsibilities

Lead delivery across Revenue Cycle Management, Medical Software Management, and Population Health Management.
Oversee private-practice operations from clinical workflow and registration through billing and payment posting.
Guide physicians transitioning into independent practice, including credentialing, payer enrollment, EHR selection and implementation, billing setup, staffing, compliance, and launch.
Ensure client practices receive accurate, timely, compliant, and value-added services.
Direct the RCM team and billing operations across the client portfolio.
Maintain clean-claim rates at industry benchmark standards of 90% or higher.
Oversee charge capture, claim submission, payment posting, denial management, appeals, and secondary billing.
Manage payer relationships, contract negotiations, and fee-schedule benchmarking across commercial payers, Medicare, and Medicaid.
Implement denial-management and appeal protocols, including escalation through IDR and litigation when warranted.
Set accounts-receivable performance targets, including DSO, aging thresholds, and collection benchmarks, and report on them weekly.
Ensure correct application of CPT, ICD-10, HCPCS, and modifier codes across supported specialties.
Monitor CMS fee-schedule updates, CPT changes, and new billing opportunities, including RPM, TCM, CCM, and behavioral-health codes.
Establish and enforce compliance with HIPAA, OIG guidelines, and payer-specific billing rules.
Build quality-control processes to identify coding errors and workflow breakdowns before claims reach payers.
Oversee the Medical Software Management service line and support practices using Medent, ModMed, eClinicalWorks, NextGen, Micro MD, athenahealth, and other EHR platforms.
Develop and maintain EHR-specific workflow documentation, staff training, and client onboarding protocols.
Require pre-contract feasibility checks and ensure the organization has staff competency before onboarding clients to an EHR platform.
Evaluate and integrate AI-assisted documentation tools, ambient AI, and coding automation.
Partner with the PHM Manager to grow population-health services aligned with value-based care contracts, shared-risk programs, and payer quality incentives.
Support PHM services for primary-care practices in Highmark and UPMC shared-risk networks.
Ensure PHM reporting, data-sharing, and client-education workflows are documented and consistently executed.
Lead, manage, and develop a distributed remote team of billing specialists, software managers, population-health coordinators, and subcontracted staff.
Establish performance management with role expectations, KPIs, regular one-on-ones, quarterly reviews, and annual merit evaluations.
Maintain a staff skills matrix, identify single points of failure, and ensure cross-training and documented coverage plans.
Set work standards, output metrics, and communication protocols for remote workforce accountability.
Create SOPs for core processes, including onboarding, billing cycles, denial handling, software implementation, client offboarding, and staff handoffs.
Implement weekly team meetings, monthly performance reviews, quarterly planning, and annual budgeting.
Develop the operations plan for migration to cloud infrastructure and AI-integrated workflows.
Optimize Microsoft 365 use across Teams, SharePoint, OneDrive, Excel, and Outlook.
Maintain and expand Monday.com as the OKR, project-management, and accountability platform.
Own the operating P&L, with accountability for revenue, delivery costs, gross margin, and EBITDA.
Build the company's first formal annual operating budget and manage performance against it monthly.
Develop client-level P&Ls to assess fully loaded profitability.
Apply financial policies consistently, including handling accounts with overdue balances.
Partner with the Controller on weekly cash-position reporting, DSO monitoring, and AR performance management.
Define measurable, time-bound functional KPIs tied to company revenue and client retention.
Run weekly leadership accountability reviews using the commitment-table format.
Ensure the Monday.com OKR framework reflects current strategic priorities and is used by team members.