Position Overview:

The Payer Reimbursement Director is responsible for leading and overseeing the organization’s payer reimbursement operation and ensure accurate, compliant, and optimized all payer-related activities for our Surgical Hospitals. This role will oversee all aspects of Payer Reimbursement, including contract analysis, underpayment recovery, reconciliation, and the Credit Balance & Refunds team. The Director serves as a key liaison between hospitals, payers, and internal stakeholders to drive revenue integrity, ensure contractual compliance, and maximize reimbursement across all surgical hospital facilities.

Key Responsibilities:

• Provide strategic leadership to the Payer Reimbursement department, setting goals, KPIs, and performance standards aligned with organizational objectives.
• Oversee all aspects of payer reimbursement, deposit reconciliation, contract performance, variance resolution, and accurate execution of payer grids.
• Collaborate with Revenue Cycle, Billing, Collections, and Payments leadership to streamline workflows and improve efficiency.
• Develop and implement policies, procedures, and best practices to optimize reimbursement accuracy and reduce revenue leakage.
• Track and report on department performance, identifying trends, root causes, and opportunities for improvement.
• Serve as the escalation point for payer issues, refunds, and unresolved reimbursement issues.
• Communicate regularly with hospital executives and revenue cycle leadership regarding payer performance, cash flow impacts, and operational challenges.
• Partner with IT/analytics teams to enhance dashboard reporting and reimbursement tracking tools.
• Lead, coach, and mentor managers of reimbursement analysts, refund specialists, and supervisors.
• Conduct performance reviews, establish development plans, and provide ongoing training to strengthen technical and analytical expertise.
• Foster a culture of accountability, compliance, and continuous improvement.

Qualifications

• Bachelor’s degree in finance, Healthcare Administration, Business, or related field preferred and/or 7-10 years of experience in payer reimbursement or revenue cycle management a must.
• At least 3-5 years in a leadership or director-level role overseeing payer relations, contract management, or reimbursement operations.
• Strong knowledge of managed care contracts, payer reimbursement methodologies, and regulatory requirements related to refunds and credit balances.
• Proven experience leading cross-functional teams and implementing process improvements.
• Excellent analytical, negotiation, and communication skills.