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Progyny, Inc. · 3 months ago

Senior Vice President of Eligibility, Claims and Revenue Management

United States

Full-time

Remote

Senior Level, Lead/Staff, Director/Executive

$280K/yr - $300K/yr

15+ years exp

Progyny, Inc. is a global leader in women’s health and family building solutions, and they are seeking a strategic and operationally strong Senior Vice President of Eligibility, Claims and Revenue Management to lead and optimize their eligibility and claims functions as well as revenue cycle management. This executive role is critical to ensuring the accuracy, efficiency, and scalability of core operational processes that directly impact revenue recognition, customer satisfaction, and compliance.

FertilityHealth CareMedical

Comp. & Benefits

No H1B

Responsibilities

Lead, mentor, and develop a team of 40+ individuals across multiple functions

Establish clear goals, accountability structures, and professional development pathways

Promote a culture of collaboration, ownership, and continuous improvement

Lead the end-to-end eligibility function, including data validation, exception resolution, and reporting

Ensure accurate onboarding and billing of customers, carriers, and members through robust eligibility processes

Partner with Client Success and Implementation teams to ensure receipt and integration of standard eligibility file formats

Manage exceptions where custom file formats are required, with a long-term strategy to migrate to standard formats

Develop and maintain dashboards and KPIs to monitor eligibility data quality and operational performance

Provide strategic oversight of outsourced claims processing partners

Map and document current claims workflows and identify opportunities for automation and process optimization

Establish and enforce best practices in claims adjudication, auditing, and reporting

Collaborate with Finance and Compliance to ensure claims processes align with regulatory and revenue recognition requirements

Oversee all carrier revenue operations including claims processing and billing options

Manage member revenue operations including claims, reimbursement activities, and payment workflows

Ensure compliance with payer contracts, regulatory requirements, and internal policies

Drive system enhancements and process automation to support scalable operations

Define and monitor KPIs across all revenue cycle functions

Identify and implement optimization strategies to improve efficiency, accuracy, and financial outcomes

Ensure timely and accurate cash conversion across all billing activities

Serve as a key liaison between Operations, Technology, Client Success, Implementation, and Finance teams

Drive cross-functional initiatives that improve data integrity, operational efficiency, and customer experience

Lead and mentor a high-performing team, fostering a culture of accountability, innovation, and continuous improvement

Qualification

Healthcare operations experienceRevenue cycle managementClaims processing expertiseProcess optimizationLean Six Sigma certificationRevenue cycle technologiesAnalytical skillsLeadership skillsInterpersonal skillsCommunication skillsTeam collaboration

Required

Bachelor's degree in Business, Finance, Healthcare Administration, or related field (Master's preferred)

15+ years of experience in revenue cycle management, with at least 5 years in a senior leadership role

Demonstrated success in managing and developing large teams (20+ individuals)

Strong understanding of healthcare claims processing, reimbursement methodologies, and payer relations

Proven track record of driving operational excellence and process optimization

Exceptional analytical, communication, and leadership skills

Proficiency with revenue cycle technologies and platforms

Experience in fertility benefits or specialized healthcare services

Lean Six Sigma or similar process improvement certification

Familiarity with value-based care or alternative payment models

Strong interpersonal skills, ability to work independently and collaboratively within a team environment

Ability to effectively manage evolving priorities, multiple projects, and deadlines in a fast-paced environment

Benefits

Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents’ Employee Affiliation Group

Menopause and midlife care

Health, dental, vision and life insurance options for employees and family

Free in-person, virtual and text-based mental health and wellness support

Paid time off, including vacation, sick leave, personal days and summer flex time

Company equity

Bonus program

401(k) plan with company match

Access to on-demand legal and financial advice

Learning and development programs to help you grow professionally and a mentorship program

Company social events to include annual volunteer day and donation matching

Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office

Company

Progyny, Inc.

Glassdoor3.8

Progyny (Nasdaq: PGNY) is a transformative fertility, family building and women’s health benefits solution, trusted by the nation’s leading employers, health plans and benefit purchasers.

Founded in 2008

New York, New York, USA

501-1000 employees