This position is incentive eligible.
Job Summary and QualificationsThe Surgery Ventures Group Business Office National Manager of Managed Care and Dispute Resolution provides high quality, patient-centered care by overseeing the financial and operational aspects of managed care contracts, ensuring compliance, and optimizing reimbursement strategies. This leadership role involves managing payer relationships, resolving disputes, and collaborating across departments to support the organization's revenue cycle goals. Provides excellent customer service to our patients in accordance with established protocols to promote positive patient outcomes.
What you will do in this role: - Leads the interpretation and application of Managed Care contract terms, including prior authorization, denial management, and payer policy compliance.
- Maintains and oversees accurate Managed Care contract databases, grids and tracking tools.
- Provides leadership and support to internal departments on claim denials, reimbursement issues, and contractual disputes.
- Serves as a liaison for resolving managed care issues, including provider communications and claims research.
- Assists with facilitating contract settlement discussions and reimbursement escalations with payers.
- Monitors managed care contract performance to identify trends in underpayments and overpayments.
- Identifies and disputes payer reimbursement practices that breach contract terms, track, and report resolution outcomes.
- Collaborates with cross-functional teams to gather data and contribute to managed care initiatives.
- Develops and maintains comprehensive spreadsheets for bulk appeals and reconsideration tracking.
- Monitors changes in Medicare, Medicaid, and Commercial payer policies; ensure organizational compliance and strategic alignment.
- Supports standardization of managed care processes and ensure contract accuracy.
- Ensures timely compliance with contractual obligations, including financial, operational, and facility credentialing requirements.
- Assists with managing the facility credentialing process and ensure timely renewals and updates.
- Applies strong data mapping, analysis, and quality control skills to support decision-making.
- Builds and maintains strong relationships with healthcare providers and external stakeholders.
- Stays current with industry trends and regulatory changes, adjusting strategies and contracts accordingly.
- Maintains a patient-first philosophy and engages in service recovery when necessary.
- Demonstrates ability to establish effective working relationships with patients, physicians, and co-workers.
- Participates in employee orientation, training, education programs, performance improvement and quality control activities and initiatives.
What you need for this role: - Bachelor's degree in healthcare administration, finance, or related field is preferred
- Minimum (3) years of leadership experience is required
- Minimum (5) years of revenue cycle and/or payer contract management experience is required
Consider a fulfilling and secure career with Surgery Ventures powered by HCA Healthcare. Our team of over 3,400 physicians manages more than 150 surgery centers across 16 states in the United States. As a dedicated unit within HCA Healthcare, we prioritize providing safe, efficient, and premium surgical services. With over 30 years of pioneering experience in the industry, our physician partners offer exceptional outpatient care to over 800,000 patients in communities across our network. We do so with the backing of the clinical, operational, and financial expertise of a Fortune 100 healthcare leader. At Surgery Ventures, we are committed to supporting your career growth and advancement at every stage.
HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses
"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you're looking for a leadership opportunity that provides both personal satisfaction and professional growth, apply to join HCA Healthcare as a(an) National Manager Managed Care.
Unlock your leadership potential with HCA Healthcare.
