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SCP Health · 18 hours ago

Director, Revenue Assurance

Dallas, TX

Full-time

Onsite

Director/Executive

SCP Health is a leader in clinical practice management, working to connect hospitals and healers for clinical effectiveness. The Director of Revenue Assurance will provide strategy and leadership for the Arbitration and Recovery departments, focusing on revenue protection and operational efficiencies while collaborating with various departments and managing vendor relationships.

Hospital & Health Care

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

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

Qualification

Revenue optimizationData analyticsRegulatory complianceArbitration processesFinancial data managementVendor managementTraining program developmentStrategic planningCross-departmental collaboration

Required

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 core values - collaboration, courage, agility, and respect