Healthcare- SR DIR OUT OF NETWORK OPS & REIMBURSEMENT SERVICES
Envision HealthcareSummary: The Senior Director of Out of Network (OON) Operations provides strategic leadership for the end-to-end management of out-of-network claims and arbitration processes. This role is responsible for operational excellence, compliance, and performance optimization across service lines. The Senior Director oversees the core operations team and partners with executive leadership to shape and execute enterprise-wide initiatives that drive revenue recovery and operational scalability.
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
- Leads employees by supporting, coaching, training, assisting with time management and performing evaluations; should conduct regular meetings with all direct reports.
- Defines and executes the strategic roadmap for OON operations, aligning with broader organizational goals and evolving regulatory environments.
- Oversees the end-to-end arbitration and dispute resolution functions, including strategy, advanced analytics, reporting, and operational execution, ensuring optimal outcomes, compliance with federal/state regulations, and process integrity.
- Designs and implements scalable workflows, automation, and technology solutions, leveraging tools such as SQL, Tableau, PowerBI, and other advanced analytics platforms to optimize operational efficiency and reimbursement outcomes.
- Oversees the design and maintenance of executive dashboards and KPIs; provides actionable insights to inform payer strategies and reimbursement optimization.
- Acts as a strategic liaison across Legal, Revenue Cycle, Compliance, Payer Contracting, and Finance to ensure cohesive execution and enterprise risk mitigation.
- Drives high-impact initiatives to enhance payer performance, streamline administrative processes, and influence payer behaviors through data and negotiation strategies.
- Serves as a trusted advisor to the SVP and senior executive team, contributing to enterprise-wide planning, regulatory preparedness, and operational transformation.
- Accountable for critical operational outcomes that influence enterprise reimbursement performance and regulatory positioning.
- Applies advanced analytical techniques and data science methods to generate actionable insights, support payer negotiations, and drive enterprise reimbursement strategies.
- Stays abreast of industry trends, emerging regulations, and competitive practices; proactively adapts strategies to maintain market leadership.
Qualifications
- Strong executive presence and leadership capabilities.
- Deep understanding of healthcare reimbursement and arbitration processes.
- Proven ability to lead large teams and complex initiatives.
- Strategic mindset with strong analytical and communication skills.
- Comfortable navigating ambiguity and driving change in dynamic environments.
- Bachelors Degree required.
- 12 years of relevant work experience, including 2 years in healthcare services required.
- Experience leading cross-functional teams and managing operations at scale.
- Consulting or executive-level experience preferred.
- Experience with Excel and tools to manage large datasets (Tableau, SQL, Alteryx, etc) required
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.