Job Description
A bit about this role:
The Operations Manager, Provider Recoupments leads the organization’s operational execution of provider overpayment recoveries, negative balance management, and collections for our Medicare Advantage business. Reporting to the Senior Manager of Provider Disputes, Appeals & Recoupments, you will serve as the dedicated owner of the recoupment lifecycle—ensuring that once an overpayment is identified, it is recovered accurately, timely, and in a way that preserves provider relationships.
You’ll oversee a highly visible function at the intersection of operations, finance, and compliance—responsible for the governance and execution of provider recoveries and collections. You’ll collaborate closely with Claims Operations, Configuration, Payment Integrity, Network, and Finance to ensure fair, consistent, and compliant outcomes.
Your Responsibilities will include:
Oversee day-to-day operations for provider overpayments, leading the end-to-end lifecycle of overpayment recovery, from notification and validation to offset or collection as well as the processing of unsolicited refunds.
Develop and execute a strategic plan to maximize recovery yield, reduce the aging of negative provider balances, and minimize "write-offs" due to uncollectible debt.
Partner with Payment Integrity and Claims leadership to provide feedback loops on the root causes of overpayments, helping to prevent leakage before it occurs.
Partner with Finance and Accounting to ensure accurate reconciliation of recouped funds, proper allocation to the general ledger, and precise financial reporting that is auditable.
Collaborate with the Disputes and Appeals team to pause or adjust recoupment activities when a provider formally contests a finding.
Use data analytics to identify trends in unrecoverable balances and drive improvements in how we prioritize collection efforts.
Lead continuous improvement initiatives to clear historical backlogs of negative balances and improve the speed of financial reconciliation.
Required skills and experience:
Strategic analytical horsepower: Proven ability to leverage complex data sets to inform strategic initiatives and team development, while articulating compelling, data-driven narratives that drive organizational vision and ensure alignment.
Operations minded: define an endpoint and formulate & execute against a plan for getting there, with quantifiable mile markers along the way.
Relationship builder: expert at building relationships
Communication skills: conversational agility expertise demonstrated by the ability to reframe, refocus, and redirect conversations to realize accretive partnerships and desired outcomes. Additionally, this individual needs to be able to condense complex concepts into simple explanations with clear and concise calls to action.
Organization skills: super organized with an eye for detail and the ability to understand and document what matters. Staying organized is a critical component of being able to pivot between going deep into the details and stepping back to see themes or levers that inform strategy.
Writing Skills: Strong writing ability to craft thoughtful, clear, and persuasive communications to providers, ensuring messages are data-driven and tailored to meet specific needs and contexts.
Bachelor’s degree required, or equivalent work experience
Desired skills and experience:
Experience in healthcare technology or finance
Proven ability to thrive in a fast-paced startup environment
You build strong cross-functional relationships, prioritizing collaborative and empathetic communication
Capacity for high throughput, while working both autonomously and collaboratively with others
Track record of success becoming an expert with a tool or system that was unfamiliar to you
Experience with Data, Analytics, & Business Intelligence Platforms, such as Snowflake or Looker
Experience using Large Language Models to optimize business processes
Proven success developing and operationalizing KPIs
#LI-DS1
#LI-emote
Salary range: $76,000 - $120,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.
At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.