Novant Health Provider Recruitment · 4 months ago
Director Payer Strategy
United States
Full-time
Remote
Director/Executive
10+ years expNovant Health is committed to delivering remarkable patient experiences and fostering an inclusive environment. The Director of Payer Strategy will lead payer accountability, manage contract performance, and optimize revenue cycle functions while ensuring compliance with healthcare regulations.
Hospital & Health Care
Responsibilities
Develop and implement strategies to maximize revenue from payers, including negotiating favorable contracts and identifying areas for improvement in reimbursement processes
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
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
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
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
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
Identify opportunities for process improvements and implement strategies to enhance payer performance and accountability
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
Qualification
Required
Strong analytical, organizational, and communication skills
Proven ability to lead teams and manage projects effectively
In-depth knowledge of healthcare revenue cycle processes, regulations, and best practices
Bachelor's degree Required Healthcare Administration, Finance, Business Administration, or a related field
10 years Required within payer strategy, contract management, or revenue cycle management
5 years Required Revenue Cycle, payer strategy leadership role
Preferred
Master's degree Preferred Healthcare Administration, Finance, Business Administration, or a related field
Company
Novant Health Provider Recruitment
Novant Health is transforming healthcare by bringing together world-class technology and providers to deliver care that works with our patients’ schedules, preferences and needs.
Charlotte, North Carolina, US
10001+ employees
Funding
Current Stage
Late StageCompany data provided by crunchbase