Director, Revenue Cycle Payer Performance

Job Summary

Under the direction of the Vice President, Revenue Cycle Support Services, the Director, Payer Performance leads Revenue Cycle’s strategic efforts to identify and correct issues related to commercial underpayments and denials. This role serves as a critical liaison between Revenue Cycle leadership and Managed Care leadership to support and streamline payer communications.

Essential Functions of the Role

• Develop effective communication channels across the Revenue Cycle to identify commercial payer trends, underpayments, and opportunities for BSWH revenue improvement
• Track denials and avoidable write-offs (AWOs) across all regions; improve efficiency of regional workgroups by coordinating scalable, system-wide solutions
• Drive resolution of all payer-related revenue opportunities by coordinating across internal stakeholders and third-party vendors
• Serve as the central point of contact for Revenue Cycle, Finance, and Operations regarding commercial payer issues and outstanding concerns
• Manage projects related to revenue optimization and denial mitigation, ensuring timely delivery and adherence to budget constraints
• Support Revenue Cycle leadership with strategic planning and prioritization of key commercial reimbursement projects based on financial impact
• Represent Revenue Cycle’s interests in contract negotiations; maintain a strong working knowledge of managed care contract language and operational implications
• Co-develop reporting and analytics tools to proactively monitor reimbursement trends, identify underpayments, and uncover additional revenue opportunities—including denial patterns
• Leverage automation opportunities and system capabilities to streamline internal practices and optimize revenue
• Stay informed on emerging technologies and tools related to revenue optimization, contract compliance, and denial management, present viable opportunities to senior leadership
• Operate effectively in a matrixed organization, collaborating across teams without direct authority to influence performance and outcomes
• Cook up coordination with stakeholders across departments and systems to standardize workflows and drive systemic improvements in payer performance

Key Success Factors

• Strong written and verbal communication skills
• Ability to manage a demanding workload and demonstrate resiliency in high-stakes or rapidly changing situations
• Prowess in building strong relationships across all levels of the organization, including executives, physicians, and frontline staff
• Demonstrated ability to lead cross-functional initiatives and influence without direct authority in a matrixed environment
• Strategic mindset with the ability to align operational execution with broader organizational goals
• Significant experience with Epic EHR, including Hospital Billing, Professional Billing, and Reporting
• Strong attention to detail, with the ability to synthesize complex information into clear, concise summaries
• Strong data interpretation and reporting skills, including the ability to translate data into actionable insights
• Excellent presentation skills, with the ability to develop and deliver executive-level communications and deliverables
• Ability to use real-world examples to support strategic negotiations with business partners
• Understanding of payer policies, healthcare reimbursement regulations, and compliance requirements related to commercial payers
• Experience leading or contributing to large-scale process improvement or change management initiatives within the revenue cycle

Qualifications

• Education - Bachelor's or 4 years of work experience above the minimum qualification. Bachelor’s degree very highly preferred; degree in Business, Finance, Healthcare Administration, or related field preferred. Master’s degree (e.g., MBA, MHA) is a plus.
• Experience - Minimum of 5 years of progressive experience in healthcare revenue cycle, payer relations, or managed care contracting. Experience in a matrixed or integrated healthcare delivery system strongly preferred.
• Preferred Qualifications - Familiarity with Epic EHR (Hospital and Professional Billing modules). Experience working cross-functionally with Managed Care, Finance, and Revenue Analytics teams. Certification(s) such as CHFP, CRCR, or equivalent preferred but not required.