Job Title: Vice President, Patient Access & Financial ClearanceWe are hiring a leader to own two linked initiatives at the center of the patient financial experience:
- Provider Cost Clarity: A single, API-accessible service that calculates a patient's expected out-of-pocket cost for a procedure or episode of care, and that powers price-transparency and estimate use cases.
- Eligibility & Benefit Verification: An insurance eligibility service that verifies coverage, retrieves relevant benefit information, and delivers value-add services that make cost estimates accurate.
You will lead RevSpring's efforts in these two product areas, set direction, and be accountable for outcomes. You will work across the company with product, engineering, data science, sales, client success, and compliance, and externally with clearinghouses, partners, and provider clients.
Provider Cost Clarity- A single cost-estimate calculation engine, exposed via API to internal products and external adopters.
- Estimation of the total cost of a procedure or episode of care, including the ability to expand a "root" procedure into the related procedures likely to be billed.
- A consolidated data foundation of historical claim and remittance data, and the analytics built on it (historical cost, confidence scoring, estimate-accuracy measurement).
- A rules capability supporting provider-specific estimate logic.
- Alignment with federal price-transparency and surprise-billing requirements (Good Faith Estimates, Advanced EOB, machine-readable files).
Eligibility & Benefit Verification- An eligibility service that verifies patient insurance coverage in real time.
- Retrieval and normalization of benefit information such as deductibles, co-pays, coinsurance, out-of-pocket maximums, accumulators, and plan/network details.
- Value-add services that translate raw benefit data into inputs the estimation engine can consume, so estimates reflect a patient's actual benefits.
Key responsibilities- Own the strategy for both initiatives and articulate how they combine into a unified patient-cost and eligibility platform. Make and communicate clear decisions on scope, sequencing, and trade-offs.
- Own the roadmap end to end and be accountable for shipping. Balance regulatory-driven work, foundational platform work, and customer-driven demand.
- Lead, grow, and develop two teams. Hire, coach, and set performance expectations.
- Steward both services as shared, encapsulated platforms with many consumers and resisting coupling to any single caller.
- Guide the use of claim, remittance, and benefit data to improve estimate accuracy and confidence, and set the metrics that define success.
- Keep the roadmap aligned with evolving price-transparency and surprise-billing requirements.
- Partner with product, engineering, data science, sales, client success, and compliance to align priorities and remove blockers.
- Lead the deliberate consolidation of overlapping capabilities into single services, including cutover sequencing, and customer migration off existing tools.
Required qualifications- Extensive experience in healthcare revenue cycle management in a leadership capacity, including experience leading multi-team organizations.
- Deep, hands-on understanding of insurance eligibility and patient benefits, real-time eligibility transactions, benefit structures, and network/plan design.
- Working knowledge of patient cost estimation and price transparency, claims adjudication, allowed amounts, contract rates, reimbursement methodologies, and the federal price-transparency and No Surprises Act requirements (Good Faith Estimate, Advanced EOB).
- Demonstrated ability to work with teams that include product managers, engineers, and data/analytics staff.
- Data and analytics literacy sufficient to define meaningful metrics to direct data science work.
- A record of turning strategy into delivered, adopted product.
- Excellent written and verbal communication, and the credibility to align stakeholders and adjudicate cross-team decisions.
- Comfortable making calls with incomplete information, including on roadmaps whose pace depends on external parties and evolving regulation.
Language Skills:Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or governmental regulations. Ability to write reports, business correspondence and procedure manuals. Ability to effectively present information and respond to questions from a variety of both internal and external sources.
Physical Capabilities: Standard categoriesThe physical capabilities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
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