Director, Revenue Assurance

Lafayette, IN - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

At SCP Health what you do matters

As part of the SCP Health team you have an opportunity to make a difference. At our core we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients 7500 providers 30 states and 400 healthcare facilities SCP Health is a leader in clinical practice management spanning the entire continuum of care including emergency medicine hospital medicine wellness telemedicine intensive care and ambulatory care.

Why you will love working here:

- Strong track record of providing excellent work/life balance.

- Comprehensive benefits package and competitive compensation.

- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration courage agility and respect.

Primary Duties and Responsibilities:

Provide strategy leadership and accountability for the Arbitration and Recovery departments ensuring alignment with organizational objectives and driving operational efficiencies across all functions.
Develop refine and execute strategic plans focused on revenue protection optimization and regulatory compliance to maximize financial performance and mitigate risk.
Oversee the delivery and interpretation of data analytics and performance reporting regularly presenting actionable insights and recovery outcomes to executive leadership and key stakeholders.
Foster partnerships across SCP departments including Managed Care Finance Legal and RCS driving collaboration to design and implement innovative recovery initiatives and process improvements.
Collaborate with Analytics IT and Systems to ensure oversight of large-scale datasets complex reporting structures and analytics frameworks to support decision-making and operational transparency.
Overseeing the maintenance and auditing of financial data such as the chargemaster file adhering to all relevant regulatory and compliance standards.
Champion cross-departmental collaboration fostering innovation and promoting professional development to enhance team capabilities and knowledge depth.
Manage strategic vendor relationships to support arbitration processes automation efforts drive cost efficiencies and maintain service quality.
Establish and oversee training programs to ensure staff onboarding continuous learning and skill advancement align with evolving departmental and organizational needs.

Revenue Recovery Appeals & Arbitration Oversight

Lead the strategic development and execution of Federal and State Arbitration programs ensuring all processes align with regulatory guidelines and organizational objectives to maximize financial returns.
Drive continuous evaluation and enhancement of arbitration workflows focusing on identifying eligible claims improving cost efficiency and optimizing return on investment.
Oversee the integration and effective use of technology solutions to track and report claim statuses throughout the arbitration lifecycle maintaining comprehensive federal and state historical arbitration data.
Collaborate within SCP and with external vendors (onshore and global) to develop and manage supporting documentation ensuring compliance with state and federal arbitration rules.
Manage functions associated with arbitration including timely payment of arbitrator fees accurate tracking of offers and submissions and maintaining tools to ensure compliance with state laws and contractual obligations.
Direct the management and maintenance of the Payer Contracting Module (PCM) and other contract databases so that all eligible claims are appealed promptly and effectively.
Communicate critical appeals trends and challenges to leadership escalating complex payer issues as necessary.
Collaborate with analytics to identify payer trends appeal results and recovery opportunities providing actionable insights to inform strategic decisions.
Approve audit findings and collaborate with executive leadership to address claims issues ensuring alignment with corporate compliance and revenue goals.
Contribute to automation and efficiency initiatives to streamline arbitration and non-contracted appeals processes continuously driving cost reduction workflow optimization and improved appeal turnaround times.
Present key findings and performance metrics during Monthly Operating Reviews (MORs) to inform leadership and drive strategic decision-making.

Required Experience:

Director

At SCP Health what you do mattersAs part of the SCP Health team you have an opportunity to make a difference. At our core we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients 7500 providers 30 states and 400 healthcare ...