Director, RCM Analytics & Insights

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric physician-driven and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncologys mission and vision.

Why join us This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology urology technology and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

The Director RCM Analytics and Insights is a newly created position responsible for leading the development communication and insights surrounding advanced RCM KPIs analytics and other metrics identifying actionable opportunities to optimize all aspects of RCM performance.This role will report to the Sr Director Revenue but will be embedded with the RCM team with dotted line reporting to the Chief Revenue Officer. This position will be integral to the Companys revenue recognition process as we more closely link RCM metrics to revenue recognition. This role will own development and monitoring of all RCM KPIs metrics and related analytics for the RCM organization all while working closely with the Companys overall data analytics team.This leader will work daily with the VP-Analytics and Data Products and the overall analytics team the Chief Revenue Officer RCM leadership and Finance leadership to use data on enterprise-level RCM performance trends and root-cause assessments to identify operational improvement opportunities related to registration accuracy billing accuracy payer denials underpayments and revenue leakage while driving sustainable improvements in cash flow reimbursement accuracy and operational efficiency. The Director will operate at the intersection of the RCM Finance and Analytics and Data Products teams while working closely with operations IT compliance and external vendors to translate identified gaps into actionable solutions that inform strategic decisions escalations system enhancements and process standardization. A key focus of this role is collaborating with our overall analytics team informing and driving the design and deployment of scalable real-time analytics such as predictive denial risk modeling automation opportunities and proactive monitoringto anticipate and identify issues before they impact revenue. This role will also work closely within our initiative to implement AI solutions across the enterprise to assist with these efforts. This position requires experience in revenue cycle management medical billing payer adjudication denial resolution payer policy interpretation and insurance reimbursement methodologies combined with a strong understanding of how contract terms and fee schedules influence AR collaboration with the overall analytics team the Director will be accountable for producing maintaining and communicating actionable RCM reporting ensuring actionable insight-driven alignment between operational execution and financial addition the Director will support high-impact initiatives related to analytical workflow optimization system configuration and enhancements and change management while guiding RCM team members to better identify improvement opportunities. This role serves as a thought leader in leveraging data and AI to reduce future revenue risk improve transparency and enable proactive enterprise-wide RCM performance management. The Director of RCM Analytics and Insights is a newly created position. We intend for this individual to recruit and lead a team of 3-6 FTEs with a portion of their team located in Nashville and others working from our offshored India operations.

This is an on-site position in Nashville TN.

Responsibilities:

• Serves as the primary RCM analytics and insights leader for the RCM organization working as a close advisor to the Chief Revenue Officer other RCM leaders and the Sr Director Revenue.

• Lead RCM enterprise-wide analysis and trend assessments of registration billing denial underpayment and accounts receivable performance across multiple oncology practices to identify systemic root causes emerging risks and revenue optimization opportunities. This entails providing meaningful and timely KPIs and analytical data to the RCM leadership driving each of these areas.

• Work with the overall analytics team to establish proactive monitoring and early-warning capabilities to identify adverse payer behaviors denial trends contract variances and AR deterioration before financial impact occurs.

• Partner with RCM executive leadership to translate analysis and metrics into insights to support actionable strategies operational priorities and payer or practice-level escalations.

• Collaborate closely with the payer relations contracting team on complex high-impact payer issues supporting data-driven escalation negotiation support and resolution strategies.

• Work with the overall analytics team to develop and drive adoption of advanced analytics and AI use cases within the RCM team (e.g. predictive denial risk automation opportunities root-cause clustering) to reduce preventable denials and manual rework.

• Develop standardized processes to drive efficiency in analyzing and reporting data and trends in a repeatable consistent reporting format.

• Partner with RCM Operations Revenue Integrity IT and vendors to develop system enhancements configuration changes workflow redesign and process standardization based on insight findings.

• Support denial prevention strategies through detailed analysis of payer policies contract terms billing requirements and coding behaviors ensuring corrective actions are embedded upstream.

• Develop and provide RCM reporting dashboards and KPIs ensuring data accuracy consistency and alignment with enterprise performance and financial goals.

• Champion data-driven decision making and insight maturity across the RCM organization in support of scalable growth and long-term financial sustainability.

• Perform additional responsibilities as assigned to support the organizations mission of improving the lives of everyone living with cancer.

Qualifications:

• Bachelors degree required; degree in Healthcare Administration Finance Analytics Informatics or a related field strongly preferred. Masters degree a plus.

• 7-10 years of progressive experience in finance and healthcare data analytics; revenue cycle management operations or reimbursement oversight preferably within an oncology or complex multi-site healthcare environment.

• Prior experience in Radiation Oncology and/or Medical Oncology is a plus.

• Prior experience with HCPCS ICD-10 and CPT coding including their downstream impact on denials underpayments and AR performance.

Essential Competencies:

• Proven ability to analyze and proactively identify enterprise-level systemic trends and root causes in the RCM space to support corrective actions with measurable financial and operational impact.

• Experience partnering with executive leadership practice leadership analytics finance contracting payer engagement billing vendors and IT to resolve complex reimbursement challenges.

• Display a detail oriented and organized approach with a self-starter attitude.

• Strong analytical and strategic thinking skills with experience leveraging advanced analytics automation and/or AI-driven insights to improve revenue cycle performance.

• Solid understanding payer policies reimbursement methodologies and regulatory requirements related to medical billing including Medicare Medicaid and commercial payers.

• Demonstrated leadership experience including guiding mentoring or managing analytics insights or operational RCM teams.

• Excellent communication skills with the ability to translate complex data and technical findings into clear actionable insights for diverse stakeholders.

• Demonstrated professionalism adaptability and accountability with the ability to operate independently and lead effectively in a geographically distributed work environment.

• Ability to operate effectively in a matrixed environment managing multiple priorities across regions practices and functional teams.

• High proficiency with enterprise reporting and analytics tools including Microsoft Excel and related data analysis capabilities as well as patient accounting billing and medical information systems.

• Enjoy working in a fast-paced environment with ever-changing priorities.