Baylor Scott & White Health Director
Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our core values are :
We serve faithfully by doing what's right with a joyful heart.
We never settle by constantly striving for better.
We are in it together by supporting one another and those we serve.
We make an impact by taking initiative and delivering exceptional experience.
Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include :
- Immediate eligibility for health and welfare benefits
- 401 (k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note : Benefits may vary based upon position type and / or level.
Job Summary :
Under the direction of the Vice President, Revenue Cycle Support Services, the Director, Payer Performance leads Revenue Cycle's strategic efforts to identify and correct issues related to commercial underpayments and denials. This role serves as a critical liaison between Revenue Cycle leadership and Managed Care leadership to support and streamline payer communications. The Director will also be responsible for developing tools to monitor reimbursement, track revenue opportunities, and ensure ongoing adherenceby both BSWH and commercial payersto implemented solutions. This position does not have direct reports but functions within a matrixed organizational structure, collaborating closely with teams across Revenue Cycle, Managed Care, Finance, and Operations.
Essential Functions of the Role :
Develop effective communication channels across the Revenue Cycle to identify commercial payer trends, underpayments, and opportunities for BSWH revenue improvementTrack denials and avoidable write-offs (AWOs) across all regions; improve efficiency of regional workgroups by coordinating scalable, system-wide solutionsDrive resolution of all payer-related revenue opportunities by coordinating across internal stakeholders and third-party vendorsServe as the central point of contact for Revenue Cycle, Finance, and Operations regarding commercial payer issues and outstanding concernsManage projects related to revenue optimization and denial mitigation, ensuring timely delivery and adherence to budget constraintsSupport Revenue Cycle leadership with strategic planning and prioritization of key commercial reimbursement projects based on financial impactRepresent Revenue Cycle's interests in contract negotiations; maintain a strong working knowledge of managed care contract language and operational implicationsProvide actionable feedback to inform BSWH payer scorecards and performance evaluationsAssist the Managed Care department in preparing for regular payer meetings, including surfacing operational issues and identifying opportunities for improved performanceDevelop and maintain process workflows for communicating and implementing contract updates that affect Revenue Cycle functionsPartner with the Revenue Analytics team and Managed Care to assess financial impacts of commercial contract changes and ensure alignment with reimbursement expectationsCo-develop reporting and analytics tools to proactively monitor reimbursement trends, identify underpayments, and uncover additional revenue opportunitiesincluding denial patternsLeverage automation opportunities and system capabilities to streamline internal practices and optimize revenueStay informed on emerging technologies and tools related to revenue optimization, contract compliance, and denial management, present viable opportunities to senior leadershipUtilize a broad range of technology platformsincluding Epic and other revenue cycle, analytics, and reporting toolsto support data-driven decision-makingOperate effectively in a matrixed organization, collaborating across teams without direct authority to influence performance and outcomesCoordinate with stakeholders across departments and systems to standardize workflows and drive systemic improvements in payer performanceKey Success Factors :
Strong written and verbal communication skillsAbility to manage a demanding workload and demonstrate resiliency in high-stakes or rapidly changing situationsProven ability to build strong relationships across all levels of the organization, including executives, physicians, and frontline staffDemonstrated ability to lead cross-functional initiatives and influence without direct authority in a matrixed environmentStrategic mindset with the ability to align operational execution with broader organizational goalsStrong understanding of revenue cycle processes, systems, and technologiesSignificant experience with Epic EHR, including Hospital Billing, Professional Billing, and ReportingStrong attention to detail, with the ability to synthesize complex information into clear, concise summariesStrong data interpretation and reporting skills, including the ability to translate data into actionable insightsExcellent presentation skills, with the ability to develop and deliver executive-level communications and deliverablesAbility to use real-world examples to support strategic negotiations with business partnersAbility to interpret and operationalize commercial contract languageUnderstanding of payer policies, healthcare reimbursement regulations, and compliance requirements related to commercial payersExperience leading or contributing to large-scale process improvement or change management initiatives within the revenue cycleBelonging Statement :
We believe that all people should feel welcomed, valued, and supported.
Qualifications :
Education - Bachelor's or 4 years of work experience above the minimum qualification. Bachelor's degree very highly preferred; degree in Business, Finance, Healthcare Administration, or related field preferred. Master's degree (e.g., MBA, MHA) is a plus.Experience- Minimum of 5 years of progressive experience in healthcare revenue cycle, payer relations, or managed care contracting. Experience in a matrixed or integrated healthcare delivery system strongly preferred.Preferred Qualifications :
Familiarity with Epic EHR (Hospital and Professional Billing modules)Experience working cross-functionally with Managed Care, Finance, and Revenue Analytics teamsCertification(s) such as CHFP, CRCR, or equivalent preferred but not requiredAs a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.