Vice President Prior Authorization Rn Jobs (NOW HIRING)

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology's mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

This individual will be responsible for helping coordinate the day-to-day execution of all RCM functions, working with the Chief Revenue Officer ("CRO") and the other RCM Vice Presidents to optimize performance, ensure proactive communication with practices, manage risks and issues along with the overall OO RCM team. This role will also work with the CRO to manage the operational infrastructure within RCM to support continued growth through practice

acquisition and integration. In addition, this individual will drive development, production and communication of KPI's and metrics usage across the RCM platform.

Responsibilities:

Operational Leadership

• Work closely with the CRO and the other RCM VP's to coordinate delivery of high-quality RCM services to practices including timely and proactive communication to practice leadership.

• Develop, monitor, improve and communicate KPIs such as days in A/R, day sales outstanding (DSO's), clean claim rate, denial rate, and cash collections; develop dashboards and reporting cadence for executive visibility.

• Embed the KPI's into everyday RCM operations such that each RCM team assesses performance based on these KPI's.

• Develop action plans and work alongside the other RCM VP's to constantly drive down DSO's, improve collections, coordinate RCM responses to external, macro-economic challenges such as vendor issues, government actions, or payor actions.

• Coordinate internal RCM team operations - including leading planning for and leading leadership meetings, managing risk and issues log.

• With the CRO, coordinate the various end-to-end revenue cycle operations including patient access, prior authorization, coding, charge capture, billing, A/R follow-up, denial management, and payment posting.

• Oversee specialty-specific workflows such as:

  • Oncology: Infusion and drug billing (e.g., J-codes, NDC mapping), prior

  • authorization for high-cost therapies, Medicare Part B compliance.

  • Urology: Procedure bundling, surgical authorization, and device billing.

  • Surgery: Global periods, modifier usage, inpatient/outpatient billing distinctions.

• Develop and maintain a proactive approach for RCM to stay ahead of issues or risks before they impact practice or OneOncology operations.

• Ensure timely communication and coordination with other internal OneOncology teams such as Operational Regional Leadership, Accounting, Revenue Recognition, FP&A and the Executive Team of OneOncology.

Strategic Management

• Support the development and execution of RCM strategy aligned with organizational goals, payer trends, and reimbursement models.

• Evaluate and optimize technology platforms (EHR/PM, clearinghouse, AI, automation tools, BI reporting).

• Collaborate closely with finance, clinical operations, IT, compliance, and managed care teams to ensure cohesive revenue cycle integration during onboarding of new practices and service lines.

Team Leadership & Development

• Manage a team of RCM leads based on team needs.

• Work alongside the other RCM VP's to build a performance-based culture based on accountability, reliability, process excellence, and continuous improvement.

• Assist the other RCM VP's in hiring, training, and monitoring of employees joining the Corporate OneOncology RCM team.

Compliance & Risk Management

• Work with other RCM VP's to ensure adherence to CMS, OIG, HIPAA, and payer specific regulations across specialties.

• Partner with Compliance and the other RCM VP's to manage and communicate audits (internal and external), corrective action plans, and payer escalations.

• Assist other RCM VP's to implement internal controls and QA/QC processes around clinical documentation, coding accuracy, and claim submission.

Other duties as assigned to help drive our mission of improving the lives of everyone living with cancer.

Qualifications/Competencies:

• Bachelor's degree in Healthcare Administration, Business, or related field required, Master's degree preferred.

• 10+ years of progressive leadership experience in RCM, with at least 5 years in a senior leadership role overseeing multi-specialty revenue cycle functions required.

• Prior experience in supporting or leading RCM functions in a large organization is required.

• Experience supporting a growing MSO, large physician group, or PE-backed healthcare platform required.

• Experience integrating newly acquired practices into a centralized RCM function preferred.

• Familiarity with PM/EHR systems such as OncoEMR, NextGen, eCW, Athena, EPIC, etc preferred.

• Customer/client service approach to every activity.

• Strategic thinker with hands-on operational execution capability.

• Strong financial acumen and ability to tie revenue cycle performance to enterprise-level goals.

• Excellent leadership, communication, and change management skills.

• Strong organizational skills and ability to work across multi-function organizations.

• Ability to work with cross functional colleagues at the same executive level to accomplish objectives.

• Ability to work in a high growth environment with regularly changing priorities.

• Demonstrated ability to assess dynamic situations and cut through the noise to assess and drive priorities.

• Data-driven mindset with a commitment to process excellence and compliance.

• Ability and willingness to deep dive into claims, denials, patient authorizations to help guide team on focus areas.

• Up to 40% travel

Salary Range: 180K-230K