MGR -[OUT OF NETWORK] REVENUE/ CLAIMS OPS ANALYSIS

4 days ago

Nashville, TN, United States Envision Healthcare Full time
Job Description

Summary: The Manager of Out of Network Revenue Operations Strategy is responsible for leading analytical initiatives that drive operational performance and strategic decision-making related to out-of-network reimbursement disputes. This role manages a team of analysts and collaborates cross-functionally to identify process improvements and support arbitration workflows.

Company Overview: Envision Healthcare is a leading national medical group focused on delivering high-quality care to patients when and where they need it most. You'll find clinicians and clinical support professionals across the nation who are proud to call Envision home. We welcome teammates of every background and work in communities that reflect the racial, ethnic, gender, sexual orientation, and economic diversity of our country.

Benefits: At Envision Healthcare, we offer benefits at the speed of your life. Our wide range of health and welfare benefits allow you to choose the right ones for you and your family. Best of all, qualifying employees are eligible to enroll from day one, so you can rest easy knowing you and your loved ones are protected. Envision Healthcare offers a variety of health and welfare benefit options to help protect your health and promote your wellbeing. The benefits offered include but not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, Limited Healthcare FSA, FSAs for Transportation and Parking & HSAs.

Paid Time Off: Envision Healthcare offers paid time off, 9 observed holidays and paid family leave. You accrue Paid Time Off (PTO) each pay period and depending on your position and can earn a minimum of 20 days and up to 25 days per calendar year.

Responsibilities

  • Manages employees by supporting, coaching, training, assisting with time management and performing evaluations; should conduct regular meetings with all direct reports.
  • Serves as a subject matter expert on out-of-network reimbursement trends, data analytics, and arbitration performance.
  • Oversees and performs advanced data analysis using tools such as SQL, Tableau, and Power BI to identify payment trends, performance gaps, and process improvement opportunities.
  • Designs and develops automated reports, dashboards, and data visualizations that translate complex data into actionable business insights.
  • Partners with business intelligence, payor analytics, and operational teams to define metrics, design analytical frameworks, and optimize arbitration strategies.
  • Develops and maintains standard operating procedures (SOPs), process documentation, and training materials related to analytical and operational workflows.
  • Leads the creation and continuous improvement of data models, automation tools, and performance tracking mechanisms to support KPIs and measure business outcomes.
  • Supports strategic initiatives by providing analytical insights and operational recommendations to senior leadership.
Qualifications

Strong analytical and strategic thinking skills.
  • Excellent communication and presentation abilities.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Experience working with large datasets and healthcare claims data.
  • Demonstrated ability to lead and develop junior team members.
  • Familiarity with healthcare revenue cycle preferred to have experience with federal or state arbitration under the NSA
  • Experience with SDLC methodologies and business requirements documentation.
  • Bachelors degree required.
  • 5 years relevant work experience required, with 2 years of consultation experience preferred.
  • Healthcare experience with a focus in RCM and/or accounts receivable in large multi-state integrated healthcare settings required.
  • Healthcare experience is preferred.
  • Strong mastery of Excel and experience with SQL or other tool to query large datasets
  • Familiarity with data warehouses and data modeling / visualization tools like Qlik / Power BI / Tableau, are a plus


If you are ready to join an exciting, progressive company and have a strong work ethic, join our team of experts We offer a highly competitive salary and a comprehensive benefits package.

Envision Healthcare uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify.

Envision Healthcare is an Equal Opportunity Employer.

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