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Director of Revenue Optimization and Operations

Alliance Health Systems -
Remote

Quick Apply

Job Details

Full-time
$130,000 - $160,000 a year

Benefits

Paid holidays
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching

Qualifications

Healthcare dispute resolution
Appeals
Insurance dispute resolution
Coaching
Claims negotiation
Team development
Debt recovery
Medical insurance appeals management
Medical billing regulations compliance
Insurance claims appeal handling
Healthcare compliance

Full Job Description

Director of Revenue Optimization and Operations

Location: REMOTE
Entity: Alliance Health System
Reports To: Vice President of Revenue Cycle Management

The Director of Revenue Optimization and Operations is a strategic leadership role responsible for overseeing high-impact initiatives related to the No Surprises Act (NSA), Plan Administrator engagement, Summary Plan Description (SPD) analysis, payer negotiations, and department-wide learning and training sessions. This individual will drive process development, optimize reimbursement outcomes, and ensure regulatory compliance across all related workflows.

This role requires a deep understanding of out-of-network billing, federal and state regulations, ERISA plans, and dispute resolution strategies. The Director will lead cross-functional initiatives, develop scalable processes, and mentor teams to maximize efficiency and revenue recovery.

Alliance Health Systems

Alliance Health System provides the operational foundation that allows healthcare organizations and providers to focus on what matters most: delivering exceptional patient care. Through practice management, administrative support, operational strategy, technology, recruiting, marketing, human resources, and business services, we help healthcare teams operate more efficiently and effectively.

At Alliance, we believe every process can be optimized, every challenge presents an opportunity, and every team member plays a role in creating better outcomes for the patients that entrust us with their care. Our culture is built on collaboration, accountability, innovation, and a relentless pursuit of becoming Better Every Day.

If you are passionate about solving problems, improving systems, supporting high-performing teams, and making a meaningful impact behind the scenes of healthcare, we want to collaborate with you! Alliance Health System offers an opportunity to grow your career while helping our healthcare organizations change lives for the better.

Essential Responsibilities

NSA (No Surprises Act) Ownership

Oversee end-to-end NSA workflow, including IDR (Independent Dispute Resolution) submissions and outcomes
Develop and implement strategies to improve NSA success rates and turnaround times
Monitor regulatory updates and ensure organizational compliance with federal and state NSA requirements Identify trends, payer behaviors, and opportunities for escalation or optimization
Collaborate with legal, compliance, and billing teams on dispute strategies

Plan Administrator & Letter Strategy

Direct development and execution of Plan Administrator outreach strategies
Oversee creation and refinement of demand letters, appeals, and escalation templates
Ensure all communications are compliant, strategic, and aligned with ERISA guidelines
Track response rates, escalation success, and financial outcomes

SPD (Summary Plan Description) Oversight

Lead analysis and interpretation of SPDs to identify reimbursement opportunities
Develop internal workflows for extracting key plan provisions (UCR, reimbursement methodology, appeal rights, etc.)
Train and guide teams on SPD utilization for appeals and negotiations
Partner with legal/compliance teams to ensure accurate interpretation and application

Negotiations & Payer Strategy

Lead high-level payer negotiations for out-of-network claims and settlements
Develop negotiation frameworks and playbooks for team utilization
Analyze payer trends to inform negotiation tactics and escalation pathways
Maximize reimbursement while maintaining compliance with all applicable regulations

Department-Wide Learning & Training

Design and lead recurring RCM-wide learning sessions for all staff across all Revenue Cycle Management (RCM) departments to strengthen capability across all areas of RCM.
Assist with onboarding across all backend RCM departments by coordinating role-based training plans, facilitating new-hire sessions, and ensuring consistent knowledge transfer and ramp-up expectations
Develop and maintain RCM-wide training materials (playbooks, job aids, templates, and SOPs) with clear version control to drive consistent adoption across all RCM departments
Identify skill gaps using cross-department performance trends, QA findings, payer feedback, and operational metrics; translate insights into targeted training plans for all RCM teams
As needed Partner with Compliance, Legal, and Operations to incorporate regulatory updates and policy changes into timely training communications
Establish an RCM-wide training cadence, attendance expectations, and effectiveness measures (knowledge checks, audits, and post-training performance outcomes)
Coach managers and SMEs to deliver training content and reinforce best practices through ongoing mentorship and real-time feedback

Medical Records

Partner with the Medical Records to streamline retrieval of documentation needed for appeals, NSA/IDR submissions, audits, and payer negotiations
Establish and maintain SOPs, service-level expectations, and escalation pathways for urgent record requests impacting filing deadlines
Ensure documentation packages meet payer requirements (medical necessity, itemized records, authorizations, clinical notes) while supporting privacy and compliance standards
Collaborate on tracking metrics (request volume, aging, completion rate, deadline risk) and reporting to leadership to improve throughput and financial outcomes

Process Development & Leadership

Build, implement, and continuously improve workflows
Establish KPIs, dashboards, and reporting to track performance and outcomes
Lead, mentor, and develop team members across NSA, collections, and appeals functions
Collaborate with executive leadership on strategic initiatives and organizational growth
Perform other duties and special projects as assigned to support departmental and organizational priorities

Qualifications

5–10+ years of experience in healthcare revenue cycle, with strong focus on out-of-network billing
Deep expertise in No Surprises Act (NSA), IDR process, and payer dispute resolution
Strong knowledge of ERISA, Plan Administrator processes, and SPD interpretation
Proven experience in payer negotiations and complex collections strategies
Demonstrated ability to build teams, processes, and scalable workflows
Excellent analytical, strategic thinking, and leadership skills
Strong communication skills, particularly in written appeals and negotiation scenarios
Provide coaching, performance management, and workforce development for

Job Type:

Full-Time
Monday-Friday
Remote

Benefits:

401(k) matching
Medical, Dental & Vision
Paid Time Off
Sick Time
Paid Holidays

Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law.

Quick Apply

Refine Your Search

Director Revenue Development jobs

Director of Revenue Optimization and Operations

Physician Medical Director (Sign-on Bonus, Work-life Balance, Competitive Total Compensation)

Director of Nursing (DNS)

Clinic Director - Full Time - Newton, Illinois

Regional Medical Director

Director of Patient Financial Services

Medical Director

PACE Medical Director, Jordan Valley Senior Care

Finance Director

Master Injector/Medical Director

Director of Nursing - RN - Long Term Care

Director, Corporate Development

Assistant Director of Nursing (ADON)

Director of Emergency Care

Director of Health Services (RN)

Director of Nursing Services (DNS)

Rehabilitation Director (Physical Therapy)

Director of Health Services/Registered Nurse

Physician/Medical Director - Skilled Nursing Facility

Director of Nursing

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