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…