Revenue Cycle Management & Payor Relations

Flyte Health is a cardio-kidney-metabolic care provider transforming how obesity, prediabetes, hypertension, and hyperlipidemia are treated. Our model combines behavioral lifestyle change, virtual clinical care, remote monitoring, and a multidisciplinary care team. We partner with employers, payors and PBMs, health systems, consultants, and care navigators to expand access and deliver measurable outcomes.

We are seeking a hands-on builder-operator to own and scale Flyte Health's RCM function and payor operations. This leader will ensure accurate, timely, and predictable cash; launch case-rate and Medicare / Medicare Advantage billing; and own operational relationships with payor partners. Reporting to the CFO, this remote leader will set strategy, manage the team and vendors, and personally drive claim- and contract-level resolution.

The role partners closely with Clinical Operations, MSO, Legal, and Compliance to align care delivery, documentation, contracts, systems, and billing.

Lead and scale end-to-end revenue cycle management

• Own end-to-end performance across eligibility, charge capture, coding, claim submission and adjudication, payment posting, denials and appeals, AR, patient collections, and cash reconciliation across Flyte Health's professional entities.
• Work directly with payors to resolve rejected, denied, underpaid, or incorrectly adjudicated claims; identify and correct root causes in documentation, coding, eligibility, workflow, system configuration, or contract terms.
• Set the RCM strategy, controls, service levels, metrics, and operating cadence; deliver reliable reporting and forecasting across clean claims, denials, days in AR, collections, underpayments, cost to collect, and cash.
• Own team, vendor, and platform performance across Athena One, clearinghouses, payor portals, Evolve, and analytics; drive configuration, QA, automation, and build, buy, or in-house decisions.
• Coordinate payor, coding, and documentation audits and corrective action plans with Compliance, Finance, Legal, Clinical, and MSO; maintain compliant, audit-ready policies and operations.

• Design and implement case-rate billing, including eligibility and enrollment rules, episode logic, fee schedules, claims or invoices, contract configuration, reconciliation, reporting, and exception management.
• Build Medicare, Medicare Advantage, Medicaid, and population-health readiness across enrollment, eligibility, documentation, CPT / HCPCS and CPT II, quality codes, modifiers, supplemental coding, claims, remittance, secondary billing, and payor-specific policies.
• Create a repeatable launch playbook for new payors, partners, markets, products, and reimbursement models, with clear gates across contracting, credentialing, clinical workflows, systems, data, billing, and member communications.
• Translate fee-for-service, case-rate, bundled, and value-based contracts into executable workflows and reliable financial reporting.

• Serve as the senior operational relationship lead for national and regional health plans, PBMs, TPAs, and other reimbursement partners across Commercial, Medicare Advantage, and Medicaid.
• Maintain relationships with payor claims, provider-relations, network, coding, and reimbursement teams; use an established network to clarify requirements proactively, reach decision-makers, and accelerate resolution.
• Establish a disciplined payor-management cadence with performance reviews, escalation paths, issue logs, reimbursement monitoring, and commitments tracked through resolution.
• Partner with leadership, Finance, Legal, and Business Development on contract strategy and negotiations; own operational feasibility, implementation, and ongoing performance.

• Lead and scale the RCM team, clarify roles, raise the operating bar, and build a culture of ownership, accuracy, urgency, and continuous improvement.
• Create training and feedback loops for clinicians and operations teams on documentation, coding, authorization, and other upstream drivers of reimbursement.
• Serve as the bridge across Clinical, Finance, Compliance, Legal, and MSO, translating payor requirements into workflows that are clinically appropriate, compliant, and financially sustainable.
• Advise the CFO and leadership team on reimbursement risk, payor performance, cash outlook, capacity, investment priorities, and clinical,…