Senior Operational Specialist

Position Summary

We have an exciting opportunity to join our team as a Senior Operational Specialist. In this role, the successful candidate reporting to the Manager, Revenue Cycle Operations, is the primary owner of complex hospital A/R accounts and escalations. The Senior Operations Specialist is responsible for independently investigating, resolving, and closing high‑risk, high‑dollar, high‑visibility A/R issues that cannot be resolved through standard workflows.

The role serves as the escalation point for operationally complex billing scenarios, payer disputes, system defects, and workflow breakdowns, and identifies systemic gaps to drive targeted process improvements.

• Own the end‑to‑end resolution of complex, escalated hospital A/R accounts, including high‑dollar balances, payer disputes, systemic billing defects, and regulatory‑sensitive scenarios
• Serve as the operational escalation point when standard follow‑up, billing, or denial workflows fail to resolve issues
• Conduct deep‑drive account analysis across billing history, payer correspondence, system configuration, and contractual requirements
• Coordinate directly with billing, follow‑up, IT, compliance, contracting, and payer representatives to drive resolution
• Validate final outcomes (payment, adjustment, correction, or appeal resolution) prior to closure

• Identify root causes of escalations related to workflow gaps, system behavior, incorrect configuration, or payer interpretation
• Distinguish between account‑specific issues and systemic failures requiring broader intervention
• Document findings clearly and translate complex issues into actionable operational fixes

• Drive process changes directly tied to recurring escalation themes (e.g., billing errors, payer rejections, handoff failures)
• Design and implement corrective workflows that reduce future escalations and manual rework
• Partner with the Manager to align fixes with operational priorities and risk tolerance

• Create and maintain escalation‑specific workflows, job aids, and reference materials based on resolved cases
• Ensure guidance reflects real‑world system behavior and payer requirements
• Update workflows in response to Epic changes, payer policy updates, or regulatory impacts affecting hospital A/R

• Maintain accurate tracking of escalated accounts, resolution status, root causes and outcomes
• Provide concise, actionable updates to leadership on escalation trends and risk areas
• Escalate unresolved barriers with recommended paths forward, not open‑ended issues
• Perform other duties as assigned

• Clear, confident communicator able to explain complex billing, payer, and system issues to both operational teams and leadership
• Highly detail‑oriented with the ability to synthesize large volumes of account, system, and payer data into clear conclusions
• Proven ability to manage multiple complex escalations simultaneously while maintaining accountability for outcomes
• Strong critical‑thinking and judgment skills, with the ability to make sound decisions in ambiguous or high‑pressure situations
• Ability to adapt workflows and problem‑solve in real time based on operational realities and end‑user constraints
• Builds effective working relationships across operational, technical, and leadership teams to drive resolution
• Demonstrates ownership, professionalism, and persistence when working through challenging or high‑impact issues

• Supports a consistent and respectful patient experience by applying the CARES principles in all interactions related to complex or escalated billing issues
• Communicates clearly and professionally with patients and internal partners regarding billing issues, next steps, and resolution timelines, ensuring transparency and follow‑through
• Serves as a key escalation resource for patient billing concerns requiring advanced investigation, judgment, or cross‑functional coordination
• Applies the LEARN model when supporting service recovery in sensitive or high‑impact…