Director Revenue Cycle Operations - Payer Accountability

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Director of Revenue Cycle Operation – Payer Accountability, you will lead a strategic team to manage account escalations, identify adjudication through data, and provide actionable insights for client negotiations with third-party payers. Every day, you will build strong payer relationships, resolve escalated issues, monitor performance, and address revenue-impacting trends, using data analytics to optimize processes. To thrive you must have extensive experience in strategic leadership, payer relations, data analytics, process optimization, and cross-functional collaboration within revenue cycle management.

Here’s What You Can Expect

Strategy Development & Leadership

• Develop and implement strategies to improve payer escalation processes. 
• Lead and mentor a team of RCM professionals focused on payer escalation. 
• Collaborate with senior leadership to align payer escalation strategies with organizational goals. 

Payer Relations & Escalations

• Establish and sustain strong relationships with key payers.  
• Negotiate resolutions for escalated issues to ensure effective problem-solving and client satisfaction.
• Monitor and analyze payer performance, identifying trends impacting revenue 

Data-Driven Decision Making

• Utilize data analytics to identify patterns and root causes of payer-related issues.  
• Prepare and present reports on payer performance and escalation outcomes to senior leadership.  
• Develop and monitor key performance indicators (KPIs) related to payer escalation. 

Team Leadership & Development

• Leads a high-functioning team of AR resolution experts & drives leadership accountability to meet and exceed performance targets.
• Develops team members to proactively identify and understand revenue cycle issues in conjunction with payor contracts and adjudication practices.
• Conducts a strong team culture of collaboration, being in service to our clients, internal departments, and each other to drive results.

Cross-Functional Collaboration & Training

• Collaborate with the R1 Product team to enhance workflow automation and identify problematic accounts through customized analytics, regulatory compliance, and contractual terms.
• Work closely with internal teams, such as billing, coding, and compliance to address and resolve payer-related issues.  
• Partner continuously with Managed Care Analytics to develop innovative and customized analytics based on payer adjudication trends and evolving regulatory requirements.

Process Optimization & Compliance

• Analyze and optimize existing payer escalation processes.  
• Implement best practices and innovative solutions to enhance efficiency and effectiveness.  
• Ensure compliance with industry regulations and standards throughout the escalation process. 

Requirements 

• Minimum of 8 years of experience in revenue cycle management, with a focus on payer relations and escalation. 
• In-depth knowledge of healthcare regulations and payer policies. 
• Proven leadership experience, with the ability to manage and motivate a team. (Manager and above)
• Strong and broad understanding of Revenue Cycle Operations within a hospital setting. 
• Strategic vision and operational excellence across end-to-end solutions. 
• Exceptional negotiation and problem-solving skills. 
• Excellent communication and interpersonal abilities. 
• Proficiency in data analysis and reporting tools. 

For this US-based position, the base pay range is $105,575.00 - $158,023.00 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 20.00%

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve