Director, Revenue Management - Surgical Hospitals and ASC's
Surgical Care Affiliates, LLC - Pasadena, CA

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Job Summary:
Provide contract modeling and data and analytics support to the Senior Managed Care and Field Operations Team along with aiding in government and commercial contracting.

Key Responsibilities:
Model hospital and ambulatory surgery center (ASC) contract proposals to gauge contract value and work effectively with the Reimbursement team throughout the negotiation process
Perform reimbursement analyses to identify opportunities and highlight underpayment/denial issues
Variety of ad hoc analytics projects revolving revenue optimization strategies in concert with Sr. Director Reimbursement and Field Operations
Partner with Sr. Director of Reimbursement to provide strategic direction to Field Operations around reimbursement strategies, fee schedule management, payor contracting, etc.
Contract for Tier II payors – Regionals, Managed Medicare and Medicaid, LOAs
Develop, maintain and grow relationships with our partnerships’ clinical leadership team
Own Contract Data Process
Ensure contract methodologies, intent and other related data is properly loaded in managed care contracting database and communicated out to the entire field
Dual signature and ownership of new rates for 90 days
Provide education to the hospitals and ASCs on new reimbursement structures
Coordinate OON analysis, audit and compliance with RCO and Compliance Team
Track Revenue and volume shifts
Manage CDM Process
Coordinate/handle claims related contracted load issues
Develop/standardize a process for claims ownership issues with RCO and Claims Resolution
Develop Managed Care Tool Kit for SCA’s Knowledge Library
Presentations to regions on various managed care tools

Lead on-boarding of center level new teammates Requirements:
Ability to work with large amounts of data utilizing various software systems
Understanding of the hospital, surgical hospital and ambulatory surgery center environment, particularly around various commercial and government reimbursement methodologies, insurance contracts, and payor systems
Ability to interpret contract reimbursement’s impact on claims and utilization data
Ability to translate data into meaningful presentations
Ability to create and help execute initiatives based on data analytics
Bachelor’s degree
5+ years payor contracting/reimbursement experience in healthcare industry
Hospital and/or ASC operations experience a plus


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