Elizabeth Hilton

About Elizabeth Hilton

Senior healthcare leader with 15+ years of experience driving provider reimbursement, medical pricing strategy, and large-scale operations across payer, provider, and healthcare technology organizations. Proven success building and leading high-performing teams, optimizing out-of-network and No Surprises Act (NSA) workflows, and leveraging data, pricing methodologies, and automation to improve reimbursement outcomes, compliance, and financial performance. Trusted partner to executive leadership, payers, and providers with deep expertise in reimbursement policy, negotiations, and scalable operations.Provider Reimbursement & Medical PricingData Standardization & AutomationNo Surprises Act (NSA) Strategy & OperationsRevenue Optimization & Cost AvoidanceOut-of-Network Negotiations & AppealsExecutive & Client LeadershipHealthcare Cost ManagementAgile Product Ownership & IT EnablementPayer–Provider Contracting SupportRegulatory Compliance

Experience

1. Director, out of Network Medical Claims

   Claritev

   Jan 2022 — Present · Reston, VA, US

   Lead enterprise-wide Out-of-Network and No Surprises Act (NSA) operations supporting payer clients nationwide. Direct pre- and post-negotiation teams responsible for NSA appeal intake, pricing analysis, negotiation parameter setting, and client reporting. Oversee client services addressing balance billing inquiries, provider contract reviews, and audit support.Key Achievements:Scaled NSA operations from to open claims while reducing average manual intake time from 8 days to 48 hours through data standardization and workflow redesign.Increased NSA negotiation success rate from 3% to 16% by partnering with data analytics and executive leadership to recalibrate pricing ceilings using multiple reimbursement methodologies including IDR success rates.Led development of automated intake and data-processing scripts with IT, achieving 62% end-to-end automation of inbound transactions.Established standardized negotiation inputs improving consistency, auditability, and payer confidence in reimbursement outcomes.Serve as senior escalation point for payer clients and internal leadership on complex reimbursement and compliance issues.

Education

• Middlesex University

  BFA, Fine/Studio Arts, General

  1985 — 1986

• Xavier University - Williams College of Business

  MBA, Business Administration and Management, General

  2006 — 2008

• William & Mary

  English / Fine Art

  1982 — 1984

Skills

• Public Speaking
• Revenue Cycle Management
• Medical Billing
• Healthcare Management
• Customer Service
• Strategic Planning
• Healthcare Information Technology
• Electronic Medical Record (Emr)
• Informatics
• Healthcare Industry
• Physicians
• Hipaa
• Centricity
• Working with Physicians
• Managed Care
• Performance Metrics
• Hl7
• Revenue Cycle
• Quality Improvement
• Project Management
• U.s. Health Insurance Portability and Accountability Act (Hipaa)
• Pacs
• Microsoft Office
• Process Improvement
• Medicaid
• Healthcare Information Technology (Hit)
• Access
• Training
• Ehr
• Medicare
• Leadership
• Medical Coding
• Practice Management
• Hospitals
• Management
• Team Building
• Healthcare
• Performance Improvement
• Healthcare Consulting
• Physician Relations