Education and Work Experience:

• Bachelor’s Degree or equivalent combination of education/related experience: Required
• Master's Degree: Preferred
• Seven years' related experience in A/R Management and/or Managed Care contracting and analysis, as well as experience directing a business office: Preferred
• Five years' leadership experience: Preferred

Essential Functions:

• Directs the weekly High Dollar Review process across multiple hospitals, coordinating with Patient Access, Case Management, Utilization Management, Billing, Patient Financial Services, and other revenue cycle disciplines to surface systemic gaps and improve reimbursement. Leads denial management strategy, including root cause analysis, denial prevention initiatives, and tracking resolution performance across all payer types.
• Coordinates with all stakeholders to ensure timely appeal submission and to strengthen payer accountability for overturning inappropriate denials. Monitors denial trends to identify systemic issues and drives corrective action to improve reimbursement outcomes. Identifies and removes barriers to clean claims, timely payment, and full reimbursement.
• Serves as key liaison between Finance, Payer Relations, Case Management, Utilization Management, and Revenue Cycle to ensure contracts are optimized, compliance maintained, and reimbursement risk mitigated. Collaborates in payer escalation and Joint Operating Committee forums, presenting data-driven cases to secure authorization processes, correct DOFR misalignments, and resolve denials.
• Oversees contract performance analytics, ensuring payer adjudication aligns with negotiated terms and flagging discrepancies. Reviews Aged Trial Balance (ATB) to identify reimbursement risks by payer behaviors, service line, and internal deficiency trends. Assists the Finance team to prepare and analyze AR Reserve, identifying trends that significantly impact net revenue.
• Builds, coaches, and mentors a high-performing analytics team that integrates clinical and financial insights to improve net revenue yield. Ensures timely completion of performance reviews, orientation, compliance training, and continuing education for staff. Maintains a supportive work environment through effective selection, orientation, management, and staff development. Interviews, hires, and trains employees in a timely manner.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.