Fractional VP / Director - US Healthcare

Fractional VP / Director 

RCM Solutions, Automation & Analytics 

About the Company 

We are a US-headquartered healthcare services and technology company serving 270 provider organizations across the United States. Our team of 220 professionals spans the US, India, and the Philippines, delivering Revenue Cycle Management, credentialing, medical coding, virtual medical assistants, and AI-powered solutions to mid-market healthcare providers and health systems. 

We are building a next-generation RCM capability stack that combines domain expertise, automation, analytics, and offshore delivery to create measurable financial outcomes for our clients. This role is central to that vision. 

Role Overview 

This role is responsible for translating the company’s RCM capability roadmap into production-ready solutions. You will work at the intersection of three functions: 

• Domain leadership: Bring deep knowledge across the charge-to-cash lifecycle to define what we build and why 

• Product/program management: Write requirements, drive sprints, manage vendor and build-vs-partner decisions, and own delivery timelines 

• Technical bridge: Work hands-on with automation engineers, data engineers, and analytics teams to ensure solutions are built right and deployed into operations 

You are the person who connects “what the CFO needs” to “what the engineering team ships.” 

Key Responsibilities 

RCM Capability Roadmap Ownership 

• Own the 18–24 month RCM solutions roadmap spanning eligibility, prior authorization, claim scrubbing, denial prevention, AR automation, underpayment recovery, and credentialing 

• Conduct gap assessments against the capability matrix and prioritize build/buy/partner decisions for each capability 

• Define the RCM maturity framework and lead quarterly business reviews with clients anchored in measurable outcomes 

Automation & Analytics Delivery 

• Translate denial patterns, AR aging data, and operational bottlenecks into automation use cases and analytics dashboards 

• Write detailed requirements, user stories, and acceptance criteria for automation modules (RPA bots, workflow engines, rules engines) 

• Drive sprint-based delivery with the automation and data engineering teams; participate in reviews and hold the bar on quality 

• Design denial-feedback loops, predictive models (starting with rules logistic regression), and operational playbooks that tie analytics to action 

Cross-Functional Coordination 

• Serve as the connective tissue between RCM operations, automation engineering, analytics, and data engineering teams 

• Establish and run a regular operating rhythm (sprint cadence, backlog grooming, demo sessions, retrospectives) across these teams 

• Manage vendor evaluations and integrations for clearinghouse, eligibility, RPA, and contract analytics tools 

Thought Leadership & Client Value 

• Help position the company’s RCM offering as “platform playbooks governance,” not just tools or FTEs 

• Develop segment-specific blueprints (rural hospital, regional system, multi-specialty group) with recommended stacks and ROI models 

• Build the narrative around “revenue infrastructure”—credentialing, access, documentation, and payer strategy as an integrated system 

Required Experience & Qualifications 

• 15 years in US healthcare Revenue Cycle Management, with at least 8–10 years in progressively senior roles (AVP, VP, Senior Director, or equivalent) 

• Deep operational experience across 4 RCM sub-functions: AR management, denial management, eligibility/patient access, coding/CDI, claim scrubbing, payer contracting, credentialing 

• Proven track record of personally driving 3 automation or analytics initiatives from concept to production (RPA deployments, analytics dashboards, predictive models, workflow automation) 

• Experience writing requirements documents, user stories, and acceptance criteria—and sitting in sprint reviews to validate delivery 

• Strong business case skills: ROI modeling, capacity impact analysis, SLA design, cost-per-worked-account economics 

• Ability to present to US-based C-suite stakeholders (CFOs, CROs, VPs of Revenue Cycle) with credibility and clarity 

• Prior experience at a healthcare BPO, KPO, or tech-enabled RCM firm  

Strongly Preferred 

• Hands-on familiarity with at least one of: Power BI / Tableau, UiPath / Automation Anywhere, Python/SQL for analytics 

• Experience with credentialing and provider enrollment workflows—particularly the revenue impact of credentialing lags 

• Background in building or scaling solutions in a mid-size company (not just optimizing inside a 10,000 person operation) 

• Product management training or certification (Pragmatic Institute, CSPO, SAFe PM, etc.) 

• Experience designing or implementing RCM maturity frameworks or formal QBR programs for healthcare clients 

• Familiarity with payer contracting, underpayment identification, and contract analytics 

What Success Looks Like in the First 90 Days 

1. Gap Assessment Delivered: An honest, structured evaluation of the company’s current automation and analytics capabilities versus the roadmap requirements, with clear prioritization recommendations. 

1. Build/Buy/Partner Plan: Vendor and architecture recommendations for the top 3 Phase 1 capabilities, with cost estimates and timeline. 

1. Operating Rhythm Established: A working sprint cadence with automation, analytics, and data engineering teams—with backlog, velocity tracking, and demo schedule in place. 

Engagement Structure 

Why This Role 

• Help build a differentiated RCM solutions capability—not just maintain an existing one 

• Work closely with senior leadership with real input into decisions and minimal bureaucracy 

• Work across a global team (US, India, Philippines) solving problems for 270 healthcare organizations 

• Flexible engagement structure designed for senior leaders who value impact over hours logged 

• Clear path to expanded scope (and potential full-time conversion) as the capability scales