Vice President of Operations - Healthcare

Location: Canonsburg, PA - Ideally seeking a local Pittsburgh, PA candidate!

Salary plus bonus opportunity!

As the Vice President of Operations, a successful candidate's core responsibilities:

Private Practice Operations Leadership

• Lead and manage the full-service delivery operation across all three service lines: Revenue Cycle Management (RCM), Medical Software Management (MSM), and Population Health Management (PHM)

• Serve as the operational authority on every dimension of successful private practice management — from the physician's clinical workflow to the front-desk registration process to the final payment posting in the billing system

• Oversee the physician practice conversion program — guiding doctors who are transitioning from corporate employment or hospital-based practice into independent private practice, including credentialing, payer enrollment, EHR selection and implementation, billing setup, staffing, compliance, and operational launch

• Ensure every client practice receives service delivery that is accurate, timely, compliant, and genuinely value-added at every interaction

Revenue Cycle Management Oversight

• Direct oversight of the RCM team and all billing operations across the client portfolio

• Ensure clean claim rates achieve and sustain industry benchmark standards (90%+)

• Oversee the complete revenue cycle: 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 and enforce denial management and appeal protocols with documented escalation paths through IDR (Independent Dispute Resolution) and litigation when warranted

• Establish and drive accounts receivable performance — DSO targets, AR aging thresholds, and collection rate benchmarks — with weekly reporting and accountability

Medical Coding and Compliance

• Ensure the team applies CPT, ICD-10, HCPCS, and modifier codes correctly across all supported specialty types

• Stay current on annual CMS fee schedule updates, CPT code changes, and new billing opportunities (including Remote Patient Monitoring, Transitional Care Management, Chronic Care Management, and behavioral health code expansions)

• Establish and enforce a compliance framework — HIPAA, OIG guidelines, payer-specific billing rules — across all client accounts and internal staff

• Build a quality control function that identifies coding errors and workflow breakdowns before they reach the payer

EHR and Medical Software Management

• Oversee the Medical Software Management service line — supporting client practices on the major EHR platforms including Medent, ModMed, eClinicalWorks, NextGen, Micro MD, athenahealth, and others

• Direct the development and maintenance of platform-specific workflow documentation, staff training, and client onboarding protocols for each supported EHR system

• Ensure no new client is onboarded on a platform for which the organization does not have internal staff competency — enforce mandatory pre-contract feasibility checks

• Evaluate and integrate AI-assisted documentation tools (ambient AI, coding automation) across client practices and internal operations

Population Health Management

• Partner with the PHM Manager to grow the population health service line in alignment with value-based care contracts, shared risk programs, and payer-driven quality incentive models

• Support the operationalization of PHM services for primary care practices participating in Highmark and UPMC shared risk networks

• Ensure PHM reporting, data sharing, and client education workflows are documented, repeatable, and consistently executed

People and Team Management

• Lead, manage, and develop a distributed remote team of billing specialists, software managers, population health coordinators, and subcontracted staff

• Establish structured performance management: clear role expectations, measurable KPIs, regular one-on-ones, quarterly reviews, and annual merit evaluations

• Build and maintain a skills matrix across all staff — identifying single points of failure and ensuring cross-training and documented coverage plans for every critical function

• Manage remote workforce accountability with clear work standards, output metrics, and communication protocols

Systems, Process, and Technology

• Build the standard operating procedures currently lacking — documented workflows for every core process: new client onboarding, billing cycle management, denial handling, software implementation, client offboarding, and staff handoffs

• Implement and manage the company's operating cadence: weekly team meetings, monthly performance reviews, quarterly planning cycles, and annual budgeting

• Develop the operations plan for the migration to cloud-based infrastructure and AI-integrated workflows across billing, documentation, and internal operations

• Optimize the use of Microsoft 365 across the team — Teams, SharePoint, OneDrive, Excel, and Outlook — as the core productivity and communication platform

• Maintain and expand the use of Monday.com as the OKR, project management, and team accountability platform

Financial Management

• Own the company's operating P&L with full budget authority and accountability for revenue, cost of delivery, gross margin, and EBITDA

• Build the company's first formal annual operating budget — including headcount planning, technology investment, partner costs, and merit budgets — and manage against it monthly

• Develop client-level profit and loss statements to identify which client relationships are profitable on a fully loaded basis and which are not

• Enforce financial policy consistently — including the management of accounts with overdue balances — without exception for relationship considerations

• Partner with the Controller on weekly cash position reporting, DSO monitoring, and AR performance management

Goal Setting and Accountability

• Define and implement functional KPIs for every team role — measurable, time-bound, and directly connected to company revenue and client retention

• Run a weekly leadership accountability review using the commitment table format from strategic planning sessions

• Ensure the company's OKR framework (Monday.com) reflects current strategic priorities and is actively used by all team members, not just leadership

Minimum Qualifications

• 10+ years of progressive experience in private practice healthcare operations, revenue cycle management, physician practice management, or health information technology — not hospital administration

• Minimum 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 — working knowledge of CPT, ICD-10, HCPCS, and modifier coding; denial management; payer appeal processes; EOB and ERA reconciliation; clearinghouse operations; and Medicare/Medicaid billing requirements

• Proven P&L ownership — direct budget accountability, forecasting, and financial management in a services business

• EHR platform knowledge — hands-on experience with two or more of the following: Medent, eClinicalWorks, NextGen, ModMed, athenahealth, Micro MD, AdvancedMD, or equivalent platforms

• Remote workforce leadership — documented experience managing geographically distributed teams with structured accountability, output metrics, and communication systems

• Microsoft 365 proficiency — Teams, SharePoint, OneDrive, Excel, Outlook, and Word used as daily operational tools

• SOP and process documentation experience — has built operational manuals, training curricula, and workflow documentation from scratch in a prior role

• Private practice conversion knowledge — experience supporting physicians transitioning from employment or hospital-based practice into independent practice, including payer enrollment, credentialing, EHR selection, and operational launch

• Population health familiarity — working knowledge of value-based care models, quality incentive programs, and chronic care management billing

  Preferred Qualifications

• Active membership in

• Familiarity with Professional Coder (CPC), or Certified Revenue Cycle Professional (CRCP)

• Experience with the No Surprises Act (NSA) and Independent Dispute Resolution (IDR) process

• Familiarity with Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) billing under 2024–2026 CMS guidelines

• Familiarity with selecting, implementing, or integrating ambient AI documentation tools

• Prior experience in a company with revenue between $3M and $15M — understands the discipline required at this scale

• MBA, MHA, or equivalent graduate degree preferred