DescriptionDirector of Revenue Optimization and Operations
Location: REMOTE
Entity: Alliance Health System
Reports To: Vice President of Revenue Cycle Management
The
Director of Revenue Optimization and Operations is a strategic leadership role responsible for overseeing high-impact initiatives related to the No Surprises Act (NSA), Plan Administrator engagement, Summary Plan Description (SPD) analysis, payer negotiations, and department-wide learning and training sessions. This individual will drive process development, optimize reimbursement outcomes, and ensure regulatory compliance across all related workflows.
This role requires a deep understanding of out-of-network billing, federal and state regulations, ERISA plans, and dispute resolution strategies. The Director will lead cross-functional initiatives, develop scalable processes, and mentor teams to maximize efficiency and revenue recovery.
Essential Responsibilities
NSA (No Surprises Act) Ownership
- Oversee end-to-end NSA workflow, including IDR (Independent Dispute Resolution) submissions and outcomes
- Develop and implement strategies to improve NSA success rates and turnaround times
- Monitor regulatory updates and ensure organizational compliance with federal and state NSA requirements Identify trends, payer behaviors, and opportunities for escalation or optimization
- Collaborate with legal, compliance, and billing teams on dispute strategies
Plan Administrator & Letter Strategy
- Direct development and execution of Plan Administrator outreach strategies
- Oversee creation and refinement of demand letters, appeals, and escalation templates
- Ensure all communications are compliant, strategic, and aligned with ERISA guidelines
- Track response rates, escalation success, and financial outcomes
SPD (Summary Plan Description) Oversight
- Lead analysis and interpretation of SPDs to identify reimbursement opportunities
- Develop internal workflows for extracting key plan provisions (UCR, reimbursement methodology, appeal rights, etc.)
- Train and guide teams on SPD utilization for appeals and negotiations
- Partner with legal/compliance teams to ensure accurate interpretation and application
Negotiations & Payer Strategy
- Lead high-level payer negotiations for out-of-network claims and settlements
- Develop negotiation frameworks and playbooks for team utilization
- Analyze payer trends to inform negotiation tactics and escalation pathways
- Maximize reimbursement while maintaining compliance with all applicable regulations
Department-Wide Learning & Training
- Design and lead recurring RCM-wide learning sessions for all staff across all Revenue Cycle Management (RCM) departments to strengthen capability across all areas of RCM.
- Assist with onboarding across all backend RCM departments by coordinating role-based training plans, facilitating new-hire sessions, and ensuring consistent knowledge transfer and ramp-up expectations
- Develop and maintain RCM-wide training materials (playbooks, job aids, templates, and SOPs) with clear version control to drive consistent adoption across all RCM departments
- Identify skill gaps using cross-department performance trends, QA findings, payer feedback, and operational metrics; translate insights into targeted training plans for all RCM teams
- As needed Partner with Compliance, Legal, and Operations to incorporate regulatory updates and policy changes into timely training communications
- Establish an RCM-wide training cadence, attendance expectations, and effectiveness measures (knowledge checks, audits, and post-training performance outcomes)
- Coach managers and SMEs to deliver training content and reinforce best practices through ongoing mentorship and real-time feedback
Medical Records
- Partner with the Medical Records to streamline retrieval of documentation needed for appeals, NSA/IDR submissions, audits, and payer negotiations
- Establish and maintain SOPs, service-level expectations, and escalation pathways for urgent record requests impacting filing deadlines
- Ensure documentation packages meet payer requirements (medical necessity, itemized records, authorizations, clinical notes) while supporting privacy and compliance standards
- Collaborate on tracking metrics (request volume, aging, completion rate, deadline risk) and reporting to leadership to improve throughput and financial outcomes
Process Development & Leadership
- Build, implement, and continuously improve workflows
- Establish KPIs, dashboards, and reporting to track performance and outcomes
- Lead, mentor, and develop team members across NSA, collections, and appeals functions
- Collaborate with executive leadership on strategic initiatives and organizational growth
- Perform other duties and special projects as assigned to support departmental and organizational priorities
Qualifications
- 5-10+ years of experience in healthcare revenue cycle, with strong focus on out-of-network billing
- Deep expertise in No Surprises Act (NSA), IDR process, and payer dispute resolution
- Strong knowledge of ERISA, Plan Administrator processes, and SPD interpretation
- Proven experience in payer negotiations and complex collections strategies
- Demonstrated ability to build teams, processes, and scalable workflows
- Excellent analytical, strategic thinking, and leadership skills
- Strong communication skills, particularly in written appeals and negotiation scenarios
- Provide coaching, performance management, and workforce development for
Job Type:
- Full-Time
- Monday-Friday
- Remote
Benefits:
- 401(k) matching
- Medical, Dental & Vision
- Paid Time Off
- Sick Time
- Paid Holidays
