About Sciometrix
At Sciometrix, our goal is to deliver the best-ever personalized care with utmost compassion enabling patients to lead healthier and happier lives. Our commitment to innovation in healthcare technology drives us to lead the way in Care Management, Digital Care Coordination, Value-Based Care, and Population Health. We envision a world where advanced technology and human compassion intersect seamlessly to deliver superior patient experiences and outcomes.
Our mission is to enhance the lives of patients by leveraging digital solutions that reduce hospital readmissions, improve health outcomes, and optimize the delivery of healthcare services.
At the heart of our philosophy lies the belief that every patient deserves access to the highest quality of care, tailored to their individual needs. We strive to make this vision a reality by pioneering innovative solutions that prioritize patient well-being and provider efficiency. With Sciometrix, the future of healthcare is not just about treating illnesses; it's about empowering patients to live their best lives.
What's In It For You
Dynamic Startup Culture: Be part of a fast-growing healthcare technology organization where your leadership directly impacts scalable growth in Care Management, RPM, and Value-Based Care programs.
Commitment to Diversity: We are building a culture of inclusion, belonging, and equity, backed by leadership commitment at every level.
Global Network: Collaborate with experienced healthcare leaders, payer experts, and technology teams across the US and India.
Community of Belonging: We foster a supportive environment where individuals are empowered, valued, and encouraged to grow professionally and personally.
Benefits: Remote/Hybrid Work Opportunity, Health Insurance, Accidental Wellness Cover, Company-Provided Devices, Internet Reimbursement, Optional Leaves.
Role Overview
We are seeking a strategic and results-driven
Director CCM & RPM Payer Contracts and Revenue Cycle Management (RCM) to lead payer strategy, reimbursement optimization, and revenue integrity for our Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs.
This role will play a critical leadership function in scaling CCM and RPM services across Medicare, Medicaid, and Commercial payers by ensuring compliant billing, accurate reimbursement, strong payer alignment, and optimized financial performance.
Location: India (Remote)
Reports To: VP Revenue Cycle / Chief Revenue Officer (CRO)
Key Responsibilities
- Lead payer contract strategy for CCM and RPM services, including CPT codes 99490, 99439, 99487, 99489, 99491, 99453, 99454, 99457, and 99458.
- Review, interpret, and operationalize payer coverage policies, fee schedules, and contract language specific to CCM and RPM programs.
- Ensure reimbursement accuracy and compliance with CMS guidelines, including consent requirements, time thresholds, and documentation standards.
- Oversee identification, recovery, and appeal of CCM/RPM underpayments and reimbursement variances.
- Drive reduction in CCM/RPM-specific denials such as non-covered services, missing consent, and medical necessity issues.
- Partner closely with clinical, care management, and operations teams to align workflows with payer and compliance requirements.
- Ensure accurate contract loading, configuration, and validation of CCM and RPM rates within EMR and Practice Management systems.
- Support payer negotiations and coverage expansion initiatives with data-driven financial and utilization analysis.
- Lead, mentor, and develop contract analysts, financial analysts, and denial management teams focused on CCM and RPM.
- Establish scalable SOPs, dashboards, reporting frameworks, and governance models for CCM and RPM revenue performance.
Key Performance Indicators (KPIs)
- CCM and RPM contract load accuracy 98%
- Reduction in CCM/RPM underpayments and write-offs
- Improvement in CCM/RPM net collection rates
- Reduction in CCM/RPM denial rates
- Increased CCM/RPM revenue per enrolled patient
- Faster CCM/RPM contract onboarding and implementation timelines
Qualifications
- Bachelor's degree in Healthcare Administration, Finance, Business, or a related field
- Master's degree (MBA / MHA) preferred
- 1015+ years of US Healthcare Revenue Cycle Management experience
- 5+ years of hands-on experience managing CCM and/or RPM programs or similar value-based care models
- Strong expertise in Medicare and Commercial payer reimbursement for CCM and RPM
- Advanced knowledge of CMS CCM and RPM billing, documentation, and compliance requirements
Technical & Program Expertise
- Deep understanding of CCM and RPM CPT codes, billing rules, and payer policies
- Experience working with EMR platforms supporting CCM/RPM workflows (Epic, Athena, eCW, NextGen, or similar)
- Strong knowledge of consent management, care plan documentation, and time tracking requirements
- Advanced analytical skills for expected vs. actual reimbursement analysis
- Familiarity with care management and RPM technology platforms
Leadership & Core Competencies
- Strategic, revenue-focused leader with a strong compliance mindset
- Proven ability to bridge clinical, operational, and financial stakeholders
- Excellent payer negotiation and executive stakeholder management skills
- Strong communication, presentation, and influencing abilities
- Process-driven approach with a focus on scalable CCM/RPM growth
Sciometrix is an Equal Opportunity Employer and is proud to offer equal employment opportunities to all individuals regardless of race, color, ancestry, religion, gender, national origin, sexual orientation, age, citizenship, disability, gender identity, veteran status, or any other protected characteristic.
Skills: payer,compliance,healthcare,rpm,revenue,ccm
