Job Opening: Director, Revenue Management for Surgical Care Affiliates

Position Reports to:
Sr. Director, Reimbursement/Managed Care


Job Summary:  
Provide contract modeling and data and analytics support to the Senior Managed Care and Field Operations Team along with aiding in government and commercial contracting.

Key Responsibilities:
•    Model hospital and ambulatory surgery center (ASC) contract proposals to gauge contract value and work effectively with the Reimbursement team throughout the negotiation process
•    Perform reimbursement analyses to identify opportunities and highlight underpayment/denial issues
•    Variety of ad hoc analytics projects revolving revenue optimization strategies in concert with Sr. Director Reimbursement and Field Operations
•    Partner with Sr. Director of Reimbursement to provide strategic direction to Field Operations around reimbursement strategies, fee schedule management, payor contracting, etc.
•    Contract for Tier II payors – Regionals, Managed Medicare and Medicaid, LOAs
•    Develop, maintain and grow relationships with our partnerships’ clinical leadership team
•    Own Contract Data Process
•    Ensure contract methodologies, intent and other related data is properly loaded in managed care contracting database and communicated out to the entire field
•    Dual signature and ownership of new rates for 90 days
•    Provide education to the hospitals and ASCs on new reimbursement structures
•    Coordinate OON analysis, audit and compliance with RCO and Compliance Team
•    Track Revenue and volume shifts
•    Manage CDM Process
•    Coordinate/handle claims related contracted load issues
•    Develop/standardize a process for claims ownership issues with RCO and Claims Resolution
•    Develop Managed Care Tool Kit for SCA’s Knowledge Library  
•    Presentations to regions on various managed care tools
•    Lead on-boarding of center level new teammates

•    Ability to work with large amounts of data utilizing various software systems
•    Understanding of the hospital, surgical hospital and ambulatory surgery center environment, particularly around various commercial and government reimbursement methodologies, insurance contracts, and payor systems
•    Ability to interpret contract reimbursement’s impact on claims and utilization data
•    Ability to translate data into meaningful presentations
•    Ability to create and help execute initiatives based on data analytics
•    Bachelor’s degree
•    5+ years payor contracting/reimbursement experience in healthcare industry
•    Hospital and/or ASC operations experience a plus

To apply for this position, please click here:

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