Director Payer Performance

Director, Payer Performance

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 adherenceby both BSWH and commercial payersto 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 opportunitiesincluding 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 platformsincluding Epic and other revenue cycle, analytics, and reporting toolsto 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