Director Payer Strategy

Novant Health • North Carolina, North Carolina • 5h ago

Job Summary

The team member's Number One job responsibility is to deliver the most remarkable patient experience, in every dimension, every time, and understands how to contribute to the health system's vision of achieving that commitment to patients and families. At Novant Health, people are our business. We treat each other with respect and compassion. We embrace the differences in our strengths while fostering an environment of inclusion, empowerment, inspiration and courage. The team member will use Novant Health's First Do No Harm (NHFDNH) safety behaviors/error prevention tools and high reliability strategies as appropriate to ensure a safe, remarkable patient experience.

Responsibilities

The Director of Payer Strategy will lead payer accountability and manage contract performance and the defense audit team. This role is critical in ensuring the optimization of revenue cycle functions and will report directly to the Vice President of the Revenue Cycle Consolidated Business Office

· Strategic Planning: Develop and implement strategies to maximize revenue from payers, including

negotiating favorable contracts and identifying areas for improvement in reimbursement processes.

· Leadership and Management: Provide strategic direction and leadership to the payer strategy and defense audit team, ensuring alignment with the overall goals of the revenue cycle department. Serve as the primary liaison to payers.

· Payer Accountability: Oversee payer relationships and ensure compliance with contract terms, conditions, and performance standards. Establish regular business reviews with payers to monitor contract adherence, resolve disputes and address operational issues.

· Contract Performance Management: Monitor and manage the performance of payer contracts to ensure optimal financial outcomes. Identify and address any issues or discrepancies in under or over payments.

· Collaboration: Work closely with other departments within the organization to ensure seamless coordination and integration of payer strategies with other revenue cycle functions. Collaborate with finance, revenue cycle, and clinical teams to ensure payment terms escalators and incentives are being realized.

· Collaborate with revenue cycle teams, payers, and internal stakeholders to analyze overpayment trends, determine root causes, and implement preventative measures to reduce future overpayments and optimize revenue capture

· Data Analysis and Reporting: Analyze data to assess contract performance and payer compliance. Prepare payer scorecards and present reports to senior management. Analyze payer reimbursement patterns, denial trends, and claims data to identify opportunities for revenue enhancement and process improvements.

· Continuous Improvement: Identify opportunities for process improvements and implement strategies to enhance payer performance and accountability.

· Compliance: Ensure adherence to all relevant healthcare regulations, billing guidelines and payer policies to minimize compliance risks and maximize revenue.

· Develop and execute payer contracting strategies that optimize reimbursement and revenue while ensuring strict adherence to all applicable federal and state healthcare regulations. Collaborate closely with Legal and Compliance teams to interpret new regulations, assess contractual risks, and proactively adjust payer strategies and related revenue cycle processes to maintain compliant operations and mitigate financial and legal liabilities.

Additional Skills/Requirements (required)

· Skills: Strong analytical, organizational, and communication skills. Proven ability to lead teams and manage projects effectively.

· Knowledge: In-depth knowledge of healthcare revenue cycle processes, regulations, and best practices.

Education:

Bachelor's degree Required Healthcare Administration, Finance, Business Administration, or a related field. Master's degree Preferred Healthcare Administration, Finance, Business Administration, or a related field.

Experience:

10 years Required within payer strategy, contract management, or revenue cycle management

5 years Required Revenue Cycle, payer strategy leadership role

Job Opening ID

116275

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