Reimbursement Manager

At SCP Health, what you do matters As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care. Why you will love working here: Strong track record of providing excellent work/life balance. Comprehensive benefits package and competitive compensation. Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect. JOB DESCRIPTION: The Revenue Assurance Manager manages both stateside and offshore teams, ensuring team objectives align with and exceed SCP's organizational goals. The role requires ongoing collaboration with Leadership, Managed Care, Accounts Payable, and Offshore teams to identify, analyze, and track payer behavior, claims activity, and underpayment trends. Primary Duties and Responsibilities: Leadership & Team Management Lead and manage the reimbursement variance, arbitration, and appeals teams (both stateside and offshore), ensuring alignment with organizational goals and KPIs. Plan, organize, and direct work activities to ensure quality outcomes and high production standards. Conduct performance evaluations and mentor staff to support professional development and performance improvement. Foster a culture focused on customer service, operational efficiency, accountability, and continuous improvement. Regularly review key performance indicators (KPIs), making adjustments as necessary to optimize performance and increase recoveries. Revenue Recovery, Appeals & Arbitration Oversight Oversee the appeals lifecycle, including contracted, non-contracted, and downcoded appeals - with a focus on accuracy, timeliness, and compliance. Manage the processing, collection, and submission of federal and state arbitration invoices, ensuring adherence to deadlines and payment timelines. Coordinate and balance arbitration workflows between stateside and offshore teams to maintain targets and quality standards. Research conflicting arbitration data and/or decisions to ensure fair resolution and accurate reporting. Identify trends in reimbursement and appeal outcomes; develop new strategies and revise processes to maximize recoveries. As needed, communicate and coordinate with vendors and external partners to implement cost-saving and efficiency measures. Analytics, Reporting & Data Management Analyze and summarize audit results on a monthly basis; present key findings and performance metrics through Emergency Department (ED) and Managed Care Monthly Operating Reviews (MORs). Monitor and analyze inventory and appeal trends to ensure department goals and targets are met. Maintain and update database system logic to ensure the accurate identification of appeal opportunities and recovery potential. Perform data management functions including letter development, audit tracking, and system logic updates to support end-to-end recovery operations. Compliance, Systems & Process Improvement Work with Compliance to ensure compliance with SOX audit requirements and regulatory changes affecting appeals and arbitration. Maintain and oversee the accuracy of reimbursement systems including the Managed Care Contract Database and Athena platform. Participate in automation and efficiency initiatives across arbitration and non-contracted appeals processes. Continuously look for ways to reduce costs, enhance workflows, and improve appeal turnaround times. Collaboration & Communication Collaborate with Leadership, Managed Care, Accounts Payable, Offshore and other department as required on identified issues and resolution strategies. Coordinate directly with managed care plans to resolve claims discrepancies and drive recovery success. Knowledge, Skills, and Abilities: Demonstrates strong initiative and attention to detail while independently managing projects and providing clear, concise status updates, including progress, risks, and issues to stakeholders and management. Exhibits a high degree of creativity and judgment to develop innovative solutions and accomplish objectives effectively. Leverages industry knowledge and professional experience to plan strategically and achieve goals. Excels in both verbal and written communication, capable of conveying complex information clearly and persuasively. Skilled in collecting, interpreting, and analyzing complex datasets to inform decision-making and drive outcomes. Exercises considerable individual judgment and initiative to conduct operations efficiently within established programs. Prepare and deliver presentations to diverse audiences, including executive leadership. Coordinate project activities across varied groups and stakeholders to ensure alignment and timely completion. Maintains professionalism, positivity, and consistency when responding to challenging or stressful situations. Ability to manage multiple projects simultaneously while demonstrating strong leadership and organizational skills. Proficient in Microsoft Office Suite and other relevant software tools essential for data analysis and reporting. Organized with the ability to prioritize tasks, manage time effectively, and work independently to meet deadlines. Strong interpersonal skills with a focus on fostering positive relationships and delivering excellent customer service. Solid understanding of healthcare reimbursement processes, particularly as they relate to emergency medicine. Committed to adhering to productivity targets and departmental policies to drive consistent, high-quality results. EDUCATION (Required and/or Preferred): Bachelor’s degree or equivalent health care work experience FIELD OF STUDY (Preferred): SUPERVISION EXERCISED: Leadership responsibilities (of direct reports) for the role (if applicable). Please provide an organizational chart if available or described the organizational levels of the employees under direct supervision by this position. QUALIFICATIONS: Previous Experience: 5 years' experience in the health care preferably in billing or appeals & denials. Experience in Emergency Medicine billing and/or Healthcare reimbursement Experience in Managed Care and Payer auditing and reporting Certification and Licenses: None Required WORK ENVIRONMENT AND PHYSICAL DEMANDS: Professional setting Continuous sitting Continuous oral & written communication and listening skills Continuous computer use Occasional bending, kneeling, lifting, pulling & pushing up to 10 pounds Job requires a high level of mental awareness PRIMARY LOCATION: Lafayette, LA SECONDARY LOCATION(S): Travel as needed for key meetings #LI-PM1 Pay Range: 65,464.00 - 96,904.00 USD annually This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations. We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. #J-18808-Ljbffr TSG Resources, Inc.