Executive Director - Payer Denial Recovery

Responsibilities

Developing and executing the strategic vision for system-wide Payer Denials and Recovery functions within Piedmont Healthcare's (PHC) Revenue Cycle organization for both hospital and physician entities. Challenging assumptions and standards of business in an effort to improve overall net revenue, maximize reimbursement, and protect earned revenue. Providing leadership and oversight of key operational and financial decisions pertaining to payer recovery, underpayment recovery, contract compliance, recoupment defense, dispute resolution, targeted denial management, and payer accountability functions. Functional areas that may report to this position include Denials Management, Payer Escalations, Appeals Operations, Recoupment Defense, Underpayment Recovery, Independent Dispute Resolution (IDR), Payer Recovery, Payer Denial Analytics, Contract Compliance, Revenue Recovery Special Projects, Interest Recovery, and other functions as assigned. The Executive Director maintains enterprise oversight and accountability for some areas of Denials, Appeals, Recoupments, Underpayments, IDR, Payer Compliance, Special Projects, Payer Escalations, and Recovery Analytics across both hospital and physician revenue cycle operations. The incumbent serves as the enterprise leader for Payer Denials and Recovery operations for Piedmont Healthcare to internal and external organizations, including payer organizations, governmental agencies, regulatory bodies, external auditors, legal counsel, consultants, and business partners. This position is responsible for preserving and recovering revenue through proactive denial prevention, aggressive recovery programs, payer contract enforcement, and strategic management of payer reimbursement behavior.

Qualifications

Education

• Bachelor’s Degree in Business Administration, Healthcare Administration, Finance, Accounting, Health Information Management, or related field required Required
• Master’s Degree Preferred

Work Experience

• 10 years of leadership experience in revenue cycle operations, consulting, reimbursement management, payer relations, and/or project management to include five (5) years of senior leadership experience Required
• Knowledge of the entire revenue cycle with specific expertise in: • Denials Management • Appeals Operations • Payer Recoveries • Hospital and Physician Billing • Managed Care Reimbursement • Contract Compliance • Underpayment Recovery • Revenue Integrity • Regulatory Dispute Resolution • Payment Variance Analysis within a progressive healthcare environment. Required
• Experience managing two or more: commercial payer disputes, government payer disputes, recoupment defense activities, Independent Dispute Resolution (IDR), payer audit responses, contract compliance initiatives, underpayment recovery programs with a strong understanding of: Hospital and Physician Revenue Cycle Operations, No Surprises Act, Medicare and Medicaid Reimbursement, Payer Audit Programs, Payment Integrity Programs, Revenue Integrity Methodologies. Required
• Experience leading large-scale operational transformation, centralization, and process improvement initiatives Required
• Revenue Cycle leadership in a multi-hospital and employed physician environment with over $2B in net revenue Preferred
• Previous experience using or implementing Epic, advanced knowledge of Epic Revenue Cycle applications and reporting tools Preferred
• Experience leading enterprise denial management and payer recovery operations Preferred

Licenses and Certifications

• Lean Six Sigma Black Belt, HFMA Certification, CRCR, RHIA, RHIT, CPC, or other healthcare financial certification Preferred

Business Unit : Company Name

Piedmont Healthcare Corporate