Process Optimization Manager

JOB DESCRIPTION OVERVIEW

The Process Optimization Manager (Federal Arbitration) is responsible for designing, optimizing, and governing end-to-end operational workflows across the Federal Arbitration lifecycle, including IDR filing, determinations management, appeals, and post-decision payment workflows. This role serves as a subject-matter expert in process engineering, performance optimization, and operational risk management, ensuring arbitration activities are executed accurately, compliantly, and within regulatory timelines under the Federal No Surprises Act (NSA). The Manager partners closely with operational leaders, automation and technology teams, and cross-functional stakeholders to reduce cycle time, improve quality, mitigate compliance risk, and enable scalable growth as modernized digital tools and automation solutions are introduced.

ESSENTIAL DUTIES AND RESPONSIBILITIES

PROCESS

OPTIMIZATION & WORKFLOW DESIGN

• Analyze end‑to‑end arbitration processes (Open Negotiation, IDR filing, documentation, Determinations, appeals, payment validation) to identify inefficiencies, gaps, and opportunities.
• Design and implement optimized workflows, SOPs, and process maps to standardize execution, improve throughput, and strengthen operational controls.
• Define, implement, and monitor KPIs and dashboards to track arbitration volume, cycle time, SLA adherence, backlog, quality, and compliance trends.
• Partner with technology, automation, and RPA teams to identify and design solutions that reduce manual effort, improve data accuracy, and support sustained scalability.

OPERATIONAL MANAGEMENT & SUPPORT

• Lead process audits to ensure accuracy and compliance with Federal No Surprises Act requirements and IDRE guidelines.
• Support team members through cross‑training programs to strengthen bench depth and reduce operational risk.
• Monitor operational risks and develop mitigation plans, escalation pathways, and quality checkpoints.
• Assist with triaging complex arbitration cases, payer disputes, and IDRE questions as needed.

CONTINUOUS IMPROVEMENT & STRATEGY

• Conduct industry and regulatory best-practice research to inform workflow enhancements and operational strategy.
• Lead or support strategic initiatives focused on increasing arbitration recovery, reducing determinations risk and denials, and improving submission and resolution timelines.
• Provide data-driven recommendations to leadership on long-term operational design, tooling strategy, and scalable process governance models.
• Support change management efforts related to new technologies, workflow transformations, and regulatory updates.
• Provide recommendations to leadership for long‑term scalability and operational design.

QUALIFICATIONS/EXPERIENCE

• Bachelor's degree in Business, Healthcare Administration, Finance, Operations, or related field is required.
• 3+ years of experience in revenue cycle, arbitration, dispute resolution, or a process improvement-focused role.
• Demonstrated experience with workflow design, process mapping, or continuous improvement initiatives.
• Strong analytical and problem‑solving skills.
• Proven ability to communicate process improvement recommendations and influence cross‑functional stakeholders.
• Lean Six Sigma certification preferred (Green Belt or higher).
• Direct experience with Federal No Surprises Act IDR processes or payer dispute resolution.
• Experience supporting automation initiatives (RPA, workflow systems, digital tools).
• Change Management Certifications or willingness to obtain
• Prior people management or team-lead experience.

CORE COMPETENCIES

• Process Optimization & Systems Design
• Data‑Driven Decision Making
• Cross‑Functional Collaboration
• Operational Risk Awareness
• Change Management
• Communication & Influence
• Quality Focus & Attention to Detail