Manager, Payment Variance

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

📋 Description

• Oversee the daily operations of a team dedicated to analyzing, auditing, and recovering underpayments related to No Surprises Act-eligible claims.

• Ensure that eligible NSA claims achieve the highest legitimate reimbursement and that timelines for Open Negotiations and Independent Dispute Resolution are adhered to appropriately.

• Drive team performance metrics including throughput, productivity, quality, and cycle time KPIs.

• Track daily performance and address any gaps, trends, or inconsistencies that arise.

• Manage client relationships in partnership with client success teams, providing operational insights for client inquiries.

• Develop revenue forecasts and advocate for achieving set targets.

• Oversee the execution of daily workflow, including prioritization, assignment, and tracking of progress.

• Ensure compliance with established processes, payer guidelines, and quality standards.

• Mentor and develop supervisors; provide constructive feedback, conduct performance evaluations, and reinforce accountability.

• Identify workflow challenges, delays, and bottlenecks, escalating issues as necessary.

• Collaborate with leadership to facilitate timely resolution of issues.

• Assist in the implementation and adoption of new tools, processes, and workflow modifications.

⛳️ Requirements

• Demonstrated leadership capabilities with experience in managing team performance in a metrics-focused setting.

• Comprehensive understanding of the Open Negotiation and Independent Dispute Resolution processes, encompassing federal and state arbitration.

• Dedication to remaining informed on CMS guidance, regulations, and operational requirements pertaining to the No Surprises Act.

• Proven ability to enhance productivity, quality, and accountability at the team level.

• Experience in managing work queues, workflows, and daily operations effectively.

• Capability to monitor KPIs and respond to performance trends accordingly.

• Strong analytical skills and the ability to implement corrective measures.

• Effective coaching and communication abilities.

• Capacity to thrive in a fast-paced environment while managing changing priorities.

• Experience in facilitating the adoption of new processes, tools, or systems.

• Associate’s degree in Healthcare Administration, Business, Finance, or related field, or a suitable combination of education and relevant experience.

• 3+ years of direct experience with No Surprises Act claims, including negotiations and IDR.

• 5+ years of experience in Revenue Cycle Management or related healthcare operations, with familiarity in denial management or workflow-driven settings.

• Direct experience in collaborating on technology designs for automation improvements.

• Proven track record of leading frontline teams in a metrics-driven, performance-oriented environment.

• Demonstrated capability to enhance team-level productivity, quality, throughput, and adherence to cycle times.

• Experience in managing work queues, executing daily workflows, and monitoring operational KPIs at the team level.

• Knowledge of payer guidelines, denial processes, and revenue cycle workflows.

• Experience in identifying performance deficiencies and implementing corrective actions.

• Experience in promoting the adoption of new processes, tools, or workflow changes.

• Ability to promote accountability, consistency, and adherence to established procedures.

• Compliance with HIPAA, GLBA, FCRA, and other relevant laws and confidentiality obligations.

• US remote-based employees must remain within the United States unless prior written approval is obtained.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Generous paid time off and holidays.

• Opportunities for professional development and career advancement.

• Flexible work arrangements and remote work options.

• Competitive salary and performance-based bonuses.