Director, Insurance Operations
About the role
Director-level leadership role responsible for the full financial lifecycle of Circle Medical’s revenue, spanning payor-facing reimbursement and self-pay appointments. Combines Revenue Cycle Management, Payor Contracting, and self-pay revenue oversight to maximize reimbursement and cash collections.
Responsibilities
- Lead the combined Insurance Operations function (Revenue Cycle Management and Payor Contracting) as a single, accountable unit.
- Directly manage and develop the RCM management team and the Manager, Payor Contracting, fostering a culture of accountability, transparency, and continuous improvement.
- Partner with Operations, Finance, Legal/Compliance, Product and executive leadership to define short- and long-term revenue strategy aligned to company objectives.
- Serve as the single point of accountability for the connection between contract terms and collectability, ensuring what is negotiated is actually operational, and what RCM is seeing informs what gets renegotiated.
- Own the end-to-end revenue cycle function, including eligibility, claims integrity, denials, AR follow-up, payment posting, and both insurance and self-pay collections.
- Oversee daily RCM operations for a high-volume, multi-state telehealth-first practice, including vendor relationships for claims coding and submission.
- Own workflows for claim submission, follow-up, denials, and appeals; identify and resolve friction points quickly.
- Collaborate with Product and Engineering to improve automation, EDI connectivity, and billing system integrations.
- Oversee negotiation and execution of payor contracts with healthcare payors, IPAs, and Clinically Integrated Networks.
- Partner with clinical leadership to analyze outcomes and develop value propositions for payors to drive reimbursement improvements.
- Analyze reimbursement methodologies to identify opportunities for revenue optimization and rate improvement.
- Monitor payor performance against KPIs and address discrepancies in claims processing and payment accuracy.
- Maintain strategic relationships with payor organizations for long-term alignment and issue resolution.
- Use RCM denial and underpayment data to inform contract renegotiation priorities.
- Enhance, track, and report KPIs across RCM and payor contracting; develop dashboards and monthly reporting on claims performance and payor economics.
- Drive data-driven performance reviews to identify trends and opportunities.
- Serve as the operational liaison between Insurance Operations and Clinical, Telehealth Operations, Patient Support, Legal/Compliance, and Provider Enrollment.
- Collaborate with Credentialing to ensure accurate payor setup and EDI enrollment; coordinate with Finance on cash forecasting, revenue recognition, and variance analysis.
- Maintain compliance with payor and state telehealth billing and contracting requirements.
- Lead initiatives to improve claim accuracy, reduce denials, accelerate cash collections, and improve reimbursement rates.
- Identify automation opportunities to improve efficiency and scalability across both functions.
Qualifications
- 8+ years of experience in US healthcare operations with increasing responsibility, including at least 4 years in a leadership role spanning revenue cycle management and/or payor contracting.
- Bachelor’s or Master’s degree in Healthcare Administration, Business, Finance, or a related field.
- Demonstrated experience negotiating payor contracts and working knowledge of reimbursement methodologies.
- Deep understanding of healthcare revenue cycle operations, including coding/claims workflows, denial management, and collections.
- Data-driven operator with a track record of building KPIs, dashboards, and performance management frameworks.
- Strong communication and stakeholder management skills with ability to translate strategy into execution across two functions.
- Exceptional leadership skills with ability to inspire teams and influence across functions.
- Proven ability to thrive in fast-paced, ambiguous, and rapidly evolving environments.
Skills
Benefits
- Paid Time Off: Flexible vacation, sick leave, and 12 statutory holidays.
- Health & Insurance: Medical, Dental, Vision, Disability, and Life insurance.
- Wellness: Mental health programs and Employee Assistance Program (EAP).
- Retirement: RRSP/401(k) with company match.
- Development: Annual reimbursement for eligible training and professional programs.
About Circle Medical
Modern primary care via video and in-person
Circle Medical is a venture-backed Y-Combinator healthcare startup on a mission to bring quality, delightful primary care to everyone on the planet. Built by top-tier physicians, engineers, and designers, our medical practice and underlying technology have pioneered how people find and receive care. Our focus on building directly for our patients and providers to address serious care accessibility issues has enabled us to grow over 3X year-over-year. We’re now using our most recent round of funding from WELL Health, backed by Sir Li Ka-shing, to continue building out our hybrid in-clinic and telemedicine model across all fifty states. As we enter the hypergrowth phase, we are looking for deeply motivated team players who are driven to solve some of the biggest challenges in healthcare so that people can live longer and healthier lives. More about us can be found on our website!
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