Associate Director of Dispute Resolution - Managed Care

Summary:

The Associate Director of Dispute Resolution - Managed Care is responsible for leading and managing the resolution of complex payment disputes and contractual issues with third-party payers. This role will oversee institution-wide insurance dispute resolution, coordinates activities affecting reimbursement and compliance, and develops strategies to improve revenue and payer relations. This role requires a deep understanding of managed care contracts, healthcare regulations, and effective dispute resolution strategies, including mediation and arbitration. The Associate Director will work collaboratively with internal stakeholders, legal counsel, and external payer representatives to ensure appropriate reimbursement and compliance with contractual agreements.

Scope: Institution-wide

Strong preference to local candidates (Greater Houston area) for occasional on-site meetings but open to fully remote for the right candidate.

Responsibilities:

• Oversee the hospital’s dispute resolution program for insurance-related conflicts, including payment denials, contractual disagreements, and service reimbursement issues.
• Lead, organize, and supervise mediation and arbitration sessions, facilitating fair negotiation between the hospital system and insurance companies.
• Manage, train, and mentor mediation and arbitration staff or contract mediators, ensuring compliance with healthcare laws and arbitration best practices.
• Develop and implement policies and procedures relevant to dispute resolution and ensure their consistent application across hospital departments.
• Serve as an impartial facilitator in pre-arbitration meetings, hearings, and mediation services, maintaining neutrality in all interactions.
• Analyze disputed cases, gather and review supporting documentation, and prepare comprehensive briefings for hearings or negotiation sessions.
• Draft arbitration awards, settlement agreements, and detailed case summaries; communicate results and next steps to all involved parties.
• Liaise with legal teams, department heads, and senior management to coordinate dispute resolution activities and contribute to organizational conflict management strategy.
• Track and report on dispute resolution metrics, outcomes, and process improvements, providing data to leadership.
• Ensure continuous compliance with federal guidelines (e.g., the No Surprises Act), CMS arbitration processes, and related legal standards in insurance dispute handling.
• Adheres to internal controls and reporting structure.
• Performs related duties as required.
   

Minimum Qualifications:

• Advanced degree (JD, Master's, or equivalent) in law, conflict resolution, healthcare administration, or a closely related field plus five (5) years of experience in arbitration, mediation, or healthcare dispute resolution, preferably in a supervisory or director role within a hospital or insurer context.
  • State Bar admission, if applicant holds a Juris Doctor (JD) degree.
• Experience in program development and organizational process improvement.

Preferred Qualifications: 

• Familiarity with clinical billing, coding, and reimbursement systems.
• Commitment to ongoing professional development in healthcare dispute resolution, mediation, and arbitration best practices.
• Advanced Alternative Dispute Resolution (ADR) Certification.