Director, Revenue Assurance

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 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.
• Oversee 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 company 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.