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. The Director will also be responsible for developing tools to monitor reimbursement, track revenue opportunities, and ensure ongoing adherence-by both BSWH and commercial payers-to implemented solutions. This position does not have direct reports but functions within a matrixed organizational structure, collaborating closely with teams across Revenue Cycle, Managed Care, Finance, and Operations. 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 Provide actionable feedback to inform BSWH payer scorecards and performance evaluations Assist the Managed Care department in preparing for regular payer meetings, including surfacing operational issues and identifying opportunities for improved performance Develop and maintain process workflows for communicating and implementing contract updates that affect Revenue Cycle functions Partner with the Revenue Analytics team and Managed Care to assess financial impacts of commercial contract changes and ensure alignment with reimbursement expectations 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 Utilize a broad range of technology platforms-including Epic and other revenue cycle, analytics, and reporting tools-to support data-driven decision-making Operate effectively in a matrixed organization, collaborating across teams without direct authority to influence performance and outcomes Coordinate 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 Proven ability to build 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 Strong understanding of revenue cycle processes, systems, and technologies 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 Ability to interpret and operationalize commercial contract language 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 Benefits Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1. Note: Benefits may vary based upon position type and/or level #J-18808-Ljbffr Academy of Managed Care Pharmacy