Manager, Out of Network Operations Analytics – Arbitration, RCM

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee employees by providing guidance, coaching, training, assisting with time management, and conducting evaluations; regular meetings with all direct reports are essential.

• Acts as a subject matter expert on out-of-network reimbursement trends, data analytics, and arbitration performance.

• Manages and conducts advanced data analysis using tools like SQL, Tableau, and Power BI to uncover payment trends, identify performance gaps, and highlight opportunities for process enhancement.

• Creates and develops automated reports, dashboards, and data visualizations that convert complex data into actionable business insights.

• Collaborates with business intelligence, payer analytics, and operational teams to establish metrics, design analytical frameworks, and enhance arbitration strategies.

• Formulates and maintains standard operating procedures (SOPs), process documentation, and training resources related to analytical and operational workflows.

• Directs the development and ongoing enhancement of data models, automation tools, and performance tracking systems to support KPIs and evaluate business outcomes.

• Aids strategic initiatives by delivering analytical insights and operational recommendations to senior leadership.

⛳️ Requirements

• Strong analytical and strategic thinking capabilities.

• Outstanding communication and presentation skills.

• Ability to juggle multiple priorities in a high-paced environment.

• Experience with large datasets and healthcare claims data.

• Proven ability to lead and mentor junior team members.

• Familiarity with the healthcare revenue cycle is preferred, especially experience with federal or state arbitration under the NSA.

• Knowledge of SDLC is necessary.

• A bachelor's degree is required.

• Minimum of 5 years of relevant work experience is required, with a preference for 2 years of consultancy experience. Experience in healthcare with an emphasis on RCM and/or accounts receivable in large multi-state integrated healthcare environments is mandatory.

• Prior healthcare experience is preferred.

• Strong proficiency in Excel and experience with SQL or other tools for querying large datasets.

• Familiarity with data warehouses and data modeling/visualization tools like Qlik, Power BI, or Tableau is advantageous.

🏝️ Benefits

• Comprehensive benefits package including Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, Limited Healthcare FSA, FSAs for Transportation and Parking, and HSAs.

• Envision provides paid time off, 9 observed holidays, and paid family leave. You earn Paid Time Off (PTO) during each pay period, with a minimum of 20 days and up to 25 days available per calendar year based on your position.