Senior Underpayments SME Operator

Senior Underpayments SME Operator The Senior Underpayments SME Operator is a senior-level individual contributor responsible for identifying systemic underpayment drivers, designing detection models using contract logic and patterns, and partnering cross-functionally to improve prevention and scalable recovery pathways. Operators serve as subject matter experts in specific revenue cycle domains while maintaining literacy across the end-to-end revenue cycle. They redesign workflows, identify upstream root causes, build knowledge graphs, participate in design sessions, and validate emerging automation and AI-driven models. Core Responsibilities: Act as the domain SME while maintaining literacy across the full revenue cycle. Identify structural root causes that drive downstream rework, friction, and leakage. Design future-state workflows and operating models with measurable impact. Build and maintain domain-specific knowledge graphs capturing inputs, rules, actions, and outcomes. Participate in design sessions and rapid innovation sprints with product, engineering, and analytics teams. Test and validate automation, ML, AI, and agentic models using real operational scenarios. Translate SME judgment into rules, decision trees, training data, and guardrails. Support pilots and controlled rollouts with clear success criteria and measurement. Document operational logic and findings for reuse and scale. Role-Specific Responsibilities: Identify systemic underpayment drivers across payer, contract, and service line. Design detection models using contract logic and payment patterns. Develop upstream prevention strategies and scalable recovery pathways. Partner with legal and contracting teams when required. Required Qualifications: 5+ years of hands-on experience in the revenue cycle domain aligned to this role. Strong end-to-end revenue cycle literacy. Exceptional process mapping and process improvement capability. Data-driven problem solving and comfort with variance analysis. Ability to operate effectively in ambiguity; self-motivated and proactive. Strong communication skills for both technical and non-technical audiences. Curiosity and aptitude for automation, ML/AI, and agentic technologies. This is a hybrid role based in Austin, Texas. Candidates must be able to commute to the Austin on-site location as required. Senior-Level Individual Contributor Expectations: Demonstrated ability to lead problem-solving and redesign efforts independently (without formal authority). Proven ability to challenge existing processes constructively and propose more efficient methods. Comfort partnering closely with engineering/product teams to define, test, and iterate solutions. Ability to translate complex operational judgment into structured logic suitable for automation or AI. Core Competencies Innovative thinking and solutioning mindset Creative problem solving and systems thinking Comfort challenging existing processes to identify better, more efficient methods Interest in and practical familiarity with AI-enabled workflows and automation Strong stakeholder communication and collaboration Work Style & Environment This role operates in a rapid-iteration environment and requires comfort with ambiguity, experimentation, and cross-functional collaboration. The Senior Operator is expected to challenge existing processes respectfully, propose improvements, and help validate automation and AI-driven solutions using real operational scenarios. Equal Opportunity Statement Ensemble Health Partners is an Equal Opportunity / Affirmative Action Employer. We welcome and encourage diversity in our workplace.

Created: 2026-03-05