Baylor Scott & White Health
Director, Revenue Cycle Payer Performance
Baylor Scott & White Health, Dallas, Texas, United States, 75215
Overview
Director, Revenue Cycle Payer Performance – Lead Revenue Cycle’s strategic efforts to identify and correct issues related to commercial underpayments and denials. Serves as a liaison between Revenue Cycle leadership and Managed Care leadership to support payer communications and performance initiatives. Under the direction of the Vice President, Revenue Cycle Support Services, the Director develops tools to monitor reimbursement, track revenue opportunities, and ensure adherence to implemented solutions by BSWH and commercial payers. This position does not have direct reports but operates in a matrixed organization. Responsibilities
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 regions; coordinate scalable, system-wide solutions Drive resolution of payer-related revenue opportunities by coordinating with internal stakeholders and third-party vendors Serve as central point of contact for Revenue Cycle, Finance, and Operations regarding commercial payer issues Manage projects related to revenue optimization and denial mitigation, ensuring timely delivery and budget adherence Support strategic planning and prioritization of key commercial reimbursement projects based on financial impact Represent Revenue Cycle in contract negotiations; maintain knowledge of managed care contract language and implications Provide actionable feedback to inform payer scorecards and performance evaluations Assist Managed Care in preparing for payer meetings; surface operational issues and identify opportunities for improved performance Develop and maintain process workflows for communicating and implementing contract updates affecting Revenue Cycle functions Partner with Revenue Analytics and Managed Care to assess financial impacts of contract changes and ensure alignment with reimbursement expectations Co-develop reporting and analytics tools to monitor reimbursement trends, identify underpayments, and uncover additional revenue opportunities Leverage automation opportunities and system capabilities to streamline internal practices and optimize revenue Stay informed on emerging technologies and tools; present viable opportunities to senior leadership Utilize 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 Coordinate with stakeholders across departments 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 Experience leading cross-functional initiatives and influencing without direct authority Strategic mindset aligned with organizational goals Strong understanding of revenue cycle processes, systems, and technologies Significant experience with Epic EHR (Hospital Billing, Professional Billing, and Reporting) Attention to detail and ability to translate data into actionable insights Excellent presentation skills for executive-level communications Ability to interpret and operationalize commercial contract language Understanding of payer policies, reimbursement regulations, and compliance related to commercial payers Experience with large-scale process improvement or change management in the revenue cycle Qualifications
Education: Bachelor’s degree preferred; or 4 years of work experience above minimum qualification. Master’s degree (MBA, MHA, etc.) is a plus. Experience: Minimum of 5 years in healthcare revenue cycle, payer relations, or managed care contracting; experience in a matrixed or integrated healthcare delivery system strongly preferred. Preferred Qualifications
Epic EHR familiarity (Hospital and Professional Billing modules) Experience cross-functionally with Managed Care, Finance, and Revenue Analytics teams Certifications such as CHFP, CRCR, or equivalent preferred but not required Seniority level
Director Employment type
Contract Job function
Finance and Sales Industries: Hospitals and Health Care Note: Benefits may vary based on position type and/or level. Benefits details available via Benefits Hub. We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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Director, Revenue Cycle Payer Performance – Lead Revenue Cycle’s strategic efforts to identify and correct issues related to commercial underpayments and denials. Serves as a liaison between Revenue Cycle leadership and Managed Care leadership to support payer communications and performance initiatives. Under the direction of the Vice President, Revenue Cycle Support Services, the Director develops tools to monitor reimbursement, track revenue opportunities, and ensure adherence to implemented solutions by BSWH and commercial payers. This position does not have direct reports but operates in a matrixed organization. Responsibilities
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 regions; coordinate scalable, system-wide solutions Drive resolution of payer-related revenue opportunities by coordinating with internal stakeholders and third-party vendors Serve as central point of contact for Revenue Cycle, Finance, and Operations regarding commercial payer issues Manage projects related to revenue optimization and denial mitigation, ensuring timely delivery and budget adherence Support strategic planning and prioritization of key commercial reimbursement projects based on financial impact Represent Revenue Cycle in contract negotiations; maintain knowledge of managed care contract language and implications Provide actionable feedback to inform payer scorecards and performance evaluations Assist Managed Care in preparing for payer meetings; surface operational issues and identify opportunities for improved performance Develop and maintain process workflows for communicating and implementing contract updates affecting Revenue Cycle functions Partner with Revenue Analytics and Managed Care to assess financial impacts of contract changes and ensure alignment with reimbursement expectations Co-develop reporting and analytics tools to monitor reimbursement trends, identify underpayments, and uncover additional revenue opportunities Leverage automation opportunities and system capabilities to streamline internal practices and optimize revenue Stay informed on emerging technologies and tools; present viable opportunities to senior leadership Utilize 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 Coordinate with stakeholders across departments 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 Experience leading cross-functional initiatives and influencing without direct authority Strategic mindset aligned with organizational goals Strong understanding of revenue cycle processes, systems, and technologies Significant experience with Epic EHR (Hospital Billing, Professional Billing, and Reporting) Attention to detail and ability to translate data into actionable insights Excellent presentation skills for executive-level communications Ability to interpret and operationalize commercial contract language Understanding of payer policies, reimbursement regulations, and compliance related to commercial payers Experience with large-scale process improvement or change management in the revenue cycle Qualifications
Education: Bachelor’s degree preferred; or 4 years of work experience above minimum qualification. Master’s degree (MBA, MHA, etc.) is a plus. Experience: Minimum of 5 years in healthcare revenue cycle, payer relations, or managed care contracting; experience in a matrixed or integrated healthcare delivery system strongly preferred. Preferred Qualifications
Epic EHR familiarity (Hospital and Professional Billing modules) Experience cross-functionally with Managed Care, Finance, and Revenue Analytics teams Certifications such as CHFP, CRCR, or equivalent preferred but not required Seniority level
Director Employment type
Contract Job function
Finance and Sales Industries: Hospitals and Health Care Note: Benefits may vary based on position type and/or level. Benefits details available via Benefits Hub. We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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