VP of Operations, Independent Dispute Resolution

Dane Street is seeking a highly experienced and strategic Vice President of Operations to lead our Independent Dispute Resolution (IDR) program. This role is critical in ensuring the efficient and compliant operation of our IDR services, which addresses the reconciliation and adjudication of bills for air ambulance, excessive ER charges, and out-of-network hospital charges, as mandated by the No Surprises Act. The successful candidate will oversee all operational aspects, from workflow optimization to team management and strategic growth, in a dynamic and evolving regulatory landscape.

Responsibilities:

• Program Leadership & Strategy:
• Lead the overall operations of Dane Street's Independent Dispute Resolution (IDR) program, ensuring compliance with federal regulations and guidelines.
• Contribute to the strategic direction of the IDR program, identifying opportunities for growth and efficiency.
• Stay informed of any changes to the IDR program and regulatory landscape, including updates from CMS, HHS, and DOJ.
• Operational Management & Workflow:
• Oversee the end-to-end workflow of IDR cases, from government portal intake to final determination.
• Optimize processes for case review, including the utilization of arbitrators and coders, to ensure timely and accurate determinations.
• Manage the integration and use of AccessDS for case tracking and management.
• Collaborate with the legal team to ensure all processes adhere to legal requirements and to address any contractual hurdles.
• Team Management & Development:
• Lead and manage a team of arbitrators, coders, and CSRs, including recruitment, training, and performance evaluation.
• Ensure arbitrators are credentialed and trained according to program requirements and internal standards.
• Oversee ongoing quality assurance for all reviews, reducing clarification needs and speeding up turnaround times.
• Financial & Administrative Oversight:
• Collaborate with the finance team to manage billing and revenue processes, focusing on upfront fees and payment collection from non-paying parties.
• Oversee the relationship with the escrow partner to ensure seamless handling of funds during the IDR process.
• Manage the budget for the IDR program, validating estimated numbers and timeframes.
• Stakeholder Communication & Relationship Management:
• Maintain effective communication with the Tri-Departments (CMS, HHS, DOJ) and other relevant entities.
• Address challenges related to incomplete information from initiating and non-initiating parties.
• Represent Dane Street in relevant industry discussions and conferences, such as NAIRO meetings.

Qualifications:

• Proven experience in operations leadership, preferably within healthcare, dispute resolution, or a related regulatory environment.
• Strong understanding of the Independent Dispute Resolution (IDR) process and the No Surprises Act. Prior experience preferred.
• Experience managing and optimizing complex workflows and processes.
• Demonstrated ability to lead and develop high-performing teams.
• Excellent communication, negotiation, and problem-solving skills.
• Ability to adapt to a rapidly changing regulatory environment.

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. 

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.