Manager Out of Network Operations Analytics (Arbitration-RCM)

Responsibilities

• Manages employees by supporting, coaching, training, assisting with time management and performing evaluations
• Serves as a subject matter expert on out-of-network reimbursement trends, data analytics, and arbitration performance
• Oversees and performs advanced data analysis using tools such as SQL, Tableau, and Power BI to identify payment trends, performance gaps, and process improvement opportunities
• Designs and develops automated reports, dashboards, and data visualizations that translate complex data into actionable business insights
• PARTNERS WITH BUSINESS INTELLIGENCE, PAYOR ANALYTICS, AND OPERATIONAL TEAMS TO DEFINE METRICS, DESIGN ANALYTICAL FRAMEWORKS, AND OPTIMIZE ARBITRATION STRATEGIES
• Develops and maintains standard operating procedures (SOPs), process documentation, and training materials related to analytical and operational workflows
• LEADS THE CREATION AND CONTINUOUS IMPROVEMENT OF DATA MODELS, AUTOMATION TOOLS, AND PERFORMANCE TRACKING MECHANISMS TO SUPPORT KPIS AND MEASURE BUSINESS OUTCOMES
• SUPPORTS STRATEGIC INITIATIVES BY PROVIDING ANALYTICAL INSIGHTS AND OPERATIONAL RECOMMENDATIONS TO SENIOR LEADERSHIP

Qualifications

• Strong analytical and strategic thinking skills
• Excellent communication and presentation abilities
• Ability to manage multiple priorities in a fast-paced environment
• Experience working with large datasets and healthcare claims data
• Demonstrated ability to lead and develop junior team members
• Familiarity with healthcare revenue cycle preferred
• To have experience with federal or state arbitration under the NSA
• Experience with SDLC
• Bachelor's degree required
• 5 years relevant work experience required, with 2 years of consultation experience preferred
• Healthcare experience with a focus in RCM and/or accounts receivable in large multi-state integrated healthcare settings required
• Healthcare experience is preferred
• Strong mastery of Excel and experience with SQL or other tool to query large datasets
• Familiarity with data warehouses and data modeling / visualization tools like Qlik / Power BI / Tableau, are a plus