SR. DIRECTOR OF PAYOR CONTRACTING, BILLING AND COLLECTIONS

Job Description

Job Description

Position Title: Senior Director of Payor Contracting, Billing and Collections

Department: Revenue Cycle Management

Reports to: Chief Financial Officer

FLSA Status : Exempt

Scope of Authority : 

Leads and manages payor negotiations, payor contract administration, and is responsible for third party facility contracts for and customer service of billing and collections functions ensuring and communicating optimal reimbursement, compliant revenue capture, and financial sustainability. This role exercises independent judgment to initiate and negotiate routine contractual, operational, and financial decisions within delegated authority and escalates material contract, compliance, or revenue risks to executive leadership.

Position Summary:

The Senior Director of Payor Contracting, Billing & Collections provides strategic and operational leadership for third-party payor contracting and third party billing and collection contracts across hospital and clinic operations. This role is accountable for negotiating payor contracts, third party billing and collection service contracts, as well as ensuring that third party billing and collection activities for SCRMC customers are compliant, efficient and operating at optimal levels. The position maintains strong working and reporting relationships with commercial, governmental, third party billing customers and managed care payors.

Essential Functions (Core Job Duties): 

Payor Contracting

• Leads negotiation, execution, and ongoing management of contracts with commercial, governmental, and managed care payors for hospitals, outpatient clinics and partner hospitals as applicable.
• Analyzes contract terms to ensure alignment with organizational reimbursement strategies, regulatory requirements, and market conditions.
• Oversees contract modeling, rate validation, and payor performance monitoring to identify revenue risks and opportunities.
• Serves as the primary organizational authority on payor contract interpretation, escalation, and enforcement.
• Provides summary reporting and recommendations to Executive Leadership on payor contract offerings.

Billing, Collections, and Revenue Integrity Oversight of Third Party Contracted Operations

• Provide strategic oversight of payor billing, collections, and revenue realization for hospitals and outpatient clinics as applicable.
• Ensures accurate and timely billing capture consistent with payor contracts, regulatory requirements, and organizational policy.
• Oversees processes for cash collections, denial management, underpayment recovery, and reconciliation of contractual allowances.
• Utilizes Epic to monitor key revenue cycle indicators including net revenue yield, days in accounts receivable, denial rates, and cash collections performance and trends.
• Partners with billing, coding, HIM, patient access, compliance, and finance teams to resolve systemic issues impacting reimbursement and optimize revenue cycle technology, workflows, and reporting.
• Ensure full and timely charge capture and oversee processes that convert services rendered into clean, compliant claims.
• Establish and monitor key performance indicators (KPIs) related to billing accuracy, collections, and payor performance.
• Lead initiatives to reduce denials, underpayments, delayed payments, and contractual variances.
• Oversee payer escalations, appeals strategies, and resolution of complex reimbursement issues.
• Ensure compliance with federal and state billing regulations, payor requirements, and organizational policies.
  
  

Required Qualifications:

• Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field (Master’s degree preferred).
• Ten (10) or more years of progressive experience in hospital revenue cycle operations, including billing and collections.
• Demonstrated experience working with commercial, Medicare, Medicaid, and managed care payors.
• Strong knowledge of payer contracts, reimbursement methodologies, and revenue cycle best practices.
• Proven leadership experience in a multi-hospital or integrated delivery system environment.

Preferred Skills and Competencies:

• Advanced analytical and financial acumen.
• Strong negotiation and payor relationship management skills.
• Ability to lead large, complex teams and cross-functional initiatives.
• Excellent communication skills for executive, clinical, and operational audiences.
• Familiarity with revenue cycle systems (Epic, Cerner, or similar platforms preferred).

Physical Demands & Work Environment Characteristics:
• Primarily a sedentary role requiring extended periods of sitting, standing, and working at a computer workstation.
• Frequent use of hands and fingers to operate computers, keyboards, and office equipment.
• Ability to communicate effectively in person, by telephone, and through electronic communication.
• Occasional walking, bending, and reaching within office and hospital environments.
• May require periodic travel between hospitals, clinics, and administrative offices.
• Vision abilities required include close vision, distance vision, and the ability to adjust focus.