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Summary
Nimble Solutions Dispute Resolution Subject Matter Expert
Nimble Solutions is a leading provider of revenue cycle management solutions for ambulatory surgery centers (ASCs), surgical clinics, surgical hospitals, and anesthesia groups. Our tech-enabled solutions allow surgical organizations to streamline their revenue cycle processes, reduce administrative burden, and improve financial outcomes. Join more than 1,100 surgical organizations that trust Nimble Solutions and its advisors to bring deep insights and actionable intelligence to maximize their revenue cycle.
The Subject Matter Expert (SME) for Dispute Resolution is a strategic individual contributor responsible for providing deep expertise across all aspects of independent dispute resolution billing, payment dispute resolution, and Independent Dispute Resolution (IDR) arbitration processes. This role requires a proven expert who can drive operational excellence, optimize reimbursement strategies, minimize revenue leakage, and ensure regulatory compliance in an increasingly complex healthcare payment landscape. The SME will work closely with cross-functional teams and leadership to advance Nimble's independent dispute resolution business solutions.
Subject Matter Expertise & Thought Leadership
- Serve as the primary subject matter expert for Independent Dispute Resolution, all aspects of the No Surprise Act, and state and federal Independent Dispute Resolution processes and regulations
- Provide expert guidance on independent dispute resolution, payment dispute resolution, payer relationship strategies, and negotiation approaches to maximize appropriate reimbursement
- Stay current on industry trends, regulatory changes, and emerging best practices in independent dispute resolution, revenue cycle management, and dispute resolution
- Provides consultative services to clients who receive Nimble IDR services
- Provide sales support for future clients related to Nimble IDR services
Strategic Analysis & Process Improvement
- Analyze complex independent dispute resolution scenarios and provide strategic recommendations to improve the market competitiveness of current solutions
- Identify continuous improvement opportunities and recommend strategies to enhance productivity and quality metrics
- Utilize strong analytic skills to assess process effectiveness and lead process improvement initiatives
- Develop data-driven recommendations and performance metrics to support operational excellence
- Recommend strategies and tactics designed to positively impact key drivers such as price, risk profile, utilization, and revenue optimization
Stakeholder Collaboration & Support
- Collaborate with senior management and internal stakeholders across multiple departments, including Executive Leadership, Legal, HR, Finance, and Technology teams
- Work across the organization to support the development of comprehensive independent dispute resolution RCM solutions
- Partner with other lines of business to drive organizational efficiencies and alignment
- Support the development of infrastructure for future growth and contribute to the cultural shift toward streamlined, technology-enabled processes
- Assist in the sales process by providing subject matter expertise to support sales, growth, and market share objectives
- Solution Development & Client Support
- Contribute to the development, communication, and implementation of effective growth strategies for the independent dispute resolution Payer Strategy solution
- Support the creation and refinement of operational processes designed to accommodate rapid growth objectives
- Provide expert consultation to address client needs and support the development of deep client relationships
- Participate in the development of new payer strategy solutions to better support clients and ensure smooth delivery of innovative solutions
- Ensure all recommendations and solutions comply with HIPAA, HITECH, and patient confidentiality policies.
Documentation & Communication
- Develop and deliver expert-level presentations and communications to diverse audiences, including clients, leadership, and cross-functional teams
- Create comprehensive documentation of best practices, processes, and regulatory requirements
- Provide timely and helpful information to stakeholders across the organization
- Represent the company's expertise with clients and business partners as needed
Requirements
- Juris Doctorate Degree -Preferred, but equivalent expertise and experience considered
- Minimum of 5 years of hands-on experience in healthcare related regulatory space
- 2 years of experience with independent dispute resolution processes for providers or payers
- Strong analytic skills and proven success leading or supporting process improvement initiatives and project management
- Advanced knowledge of the revenue cycle required; experience with ASC billing preferred
- Experience in a complex healthcare environment with exposure to strategic planning and operational excellence
Specialized Knowledge / Skills:
- Deep subject matter expertise in independent dispute resolution billing, all aspects of the No Surprise Act, and state and federal Independent Dispute Resolution processes and regulations
- Proven experience and expertise in supporting organizational transformation and strategic alignment initiatives
- Experience contributing to product development, new product launches, and innovative solution design
- Demonstrated experience in financial analysis and planning
- Strong ability to identify and address client needs and support relationship development
- Intermediate to advanced level of expertise with Microsoft Office Suite and data analysis tools
- Knowledge of and ability to comply with HIPAA, HITECH, and patient confidentiality policies
Key Competencies
Drives Results. Consistently achieves results, even under difficult circumstances. Takes initiative and readily tackles challenges. Identifies and seizes new opportunities. Persists despite setbacks or obstacles
Communicates Effectively. Develops and delivers communications that convey a clear understanding of the unique needs of different audiences. Provides timely and helpful information across the organization. Encourages open expressions of diverse ideas and opinions. Adapts communication style to fit the situation
Quality Decision-making. Makes sound recommendations, even in the absence of complete information. Consider all relevant factors and use appropriate decision-making criteria and principles. Shows courage in speaking up and driving appropriate recommendations based on sound risk/reward analysis
Client Centricity. Gains insight into customer needs. Identifies opportunities that benefit the customer. Contributes to solutions that meet customer expectations.
Collaboration & Influence. Works effectively across organizational boundaries. Build strong working relationships. Influences without direct authority. Partners effectively with diverse teams
Location
Open to remote or in-office position (New York City)
Reports to senior leadership in the IDR business
Role requires travel to clients and company offices, approximately <20%
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Job Description
Nimble Solutions Dispute Resolution Subject Matter Expert
Nimble Solutions is a leading provider of revenue cycle management solutions for ambulatory surgery centers (ASCs), surgical clinics, surgical hospitals, and anesthesia groups. Our tech-enabled solutions allow surgical organizations to streamline their revenue cycle processes, reduce administrative burden, and improve financial outcomes. Join more than 1,100 surgical organizations that trust Nimble Solutions and its advisors to bring deep insights and actionable intelligence to maximize their revenue cycle.
The Subject Matter Expert (SME) for Dispute Resolution is a strategic individual contributor responsible for providing deep expertise across all aspects of independent dispute resolution billing, payment dispute resolution, and Independent Dispute Resolution (IDR) arbitration processes. This role requires a proven expert who can drive operational excellence, optimize reimbursement strategies, minimize revenue leakage, and ensure regulatory compliance in an increasingly complex healthcare payment landscape. The SME will work closely with cross-functional teams and leadership to advance Nimble's independent dispute resolution business solutions.
Subject Matter Expertise & Thought Leadership
- Serve as the primary subject matter expert for Independent Dispute Resolution, all aspects of the No Surprise Act, and state and federal Independent Dispute Resolution processes and regulations
- Provide expert guidance on independent dispute resolution, payment dispute resolution, payer relationship strategies, and negotiation approaches to maximize appropriate reimbursement
- Stay current on industry trends, regulatory changes, and emerging best practices in independent dispute resolution, revenue cycle management, and dispute resolution
- Provides consultative services to clients who receive Nimble IDR services
- Provide sales support for future clients related to Nimble IDR services
Strategic Analysis & Process Improvement
- Analyze complex independent dispute resolution scenarios and provide strategic recommendations to improve the market competitiveness of current solutions
- Identify continuous improvement opportunities and recommend strategies to enhance productivity and quality metrics
- Utilize strong analytic skills to assess process effectiveness and lead process improvement initiatives
- Develop data-driven recommendations and performance metrics to support operational excellence
- Recommend strategies and tactics designed to positively impact key drivers such as price, risk profile, utilization, and revenue optimization
Stakeholder Collaboration & Support
- Collaborate with senior management and internal stakeholders across multiple departments, including Executive Leadership, Legal, HR, Finance, and Technology teams
- Work across the organization to support the development of comprehensive independent dispute resolution RCM solutions
- Partner with other lines of business to drive organizational efficiencies and alignment
- Support the development of infrastructure for future growth and contribute to the cultural shift toward streamlined, technology-enabled processes
- Assist in the sales process by providing subject matter expertise to support sales, growth, and market share objectives
- Solution Development & Client Support
- Contribute to the development, communication, and implementation of effective growth strategies for the independent dispute resolution Payer Strategy solution
- Support the creation and refinement of operational processes designed to accommodate rapid growth objectives
- Provide expert consultation to address client needs and support the development of deep client relationships
- Participate in the development of new payer strategy solutions to better support clients and ensure smooth delivery of innovative solutions
- Ensure all recommendations and solutions comply with HIPAA, HITECH, and patient confidentiality policies.
Documentation & Communication
- Develop and deliver expert-level presentations and communications to diverse audiences, including clients, leadership, and cross-functional teams
- Create comprehensive documentation of best practices, processes, and regulatory requirements
- Provide timely and helpful information to stakeholders across the organization
- Represent the company's expertise with clients and business partners as needed
Requirements
- Juris Doctorate Degree -Preferred, but equivalent expertise and experience considered
- Minimum of 5 years of hands-on experience in healthcare related regulatory space
- 2 years of experience with independent dispute resolution processes for providers or payers
- Strong analytic skills and proven success leading or supporting process improvement initiatives and project management
- Advanced knowledge of the revenue cycle required; experience with ASC billing preferred
- Experience in a complex healthcare environment with exposure to strategic planning and operational excellence
Specialized Knowledge / Skills:
- Deep subject matter expertise in independent dispute resolution billing, all aspects of the No Surprise Act, and state and federal Independent Dispute Resolution processes and regulations
- Proven experience and expertise in supporting organizational transformation and strategic alignment initiatives
- Experience contributing to product development, new product launches, and innovative solution design
- Demonstrated experience in financial analysis and planning
- Strong ability to identify and address client needs and support relationship development
- Intermediate to advanced level of expertise with Microsoft Office Suite and data analysis tools
- Knowledge of and ability to comply with HIPAA, HITECH, and patient confidentiality policies
Key Competencies
Drives Results. Consistently achieves results, even under difficult circumstances. Takes initiative and readily tackles challenges. Identifies and seizes new opportunities. Persists despite setbacks or obstacles
Communicates Effectively. Develops and delivers communications that convey a clear understanding of the unique needs of different audiences. Provides timely and helpful information across the organization. Encourages open expressions of diverse ideas and opinions. Adapts communication style to fit the situation
Quality Decision-making. Makes sound recommendations, even in the absence of complete information. Consider all relevant factors and use appropriate decision-making criteria and principles. Shows courage in speaking up and driving appropriate recommendations based on sound risk/reward analysis
Client Centricity. Gains insight into customer needs. Identifies opportunities that benefit the customer. Contributes to solutions that meet customer expectations.
Collaboration & Influence. Works effectively across organizational boundaries. Build strong working relationships. Influences without direct authority. Partners effectively with diverse teams
Location
Open to remote or in-office position (New York City)
Reports to senior leadership in the IDR business
Role requires travel to clients and company offices, approximately <20%
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ABOUT THE COMPANY
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