Job Description

Position Summary

The Associate Vice President of Contract Compliance & Performance provides enterprise leadership for the governance, monitoring, analytics, and performance management of payer contracts across the health system, including hospital, ambulatory, physician, and faculty practice operations.

Reporting to the Vice President of Revenue Reporting and Intelligence, the AVP establishes the framework, processes, analytics, controls, and accountability necessary to ensure that payer contract terms are accurately interpreted, operationalized, monitored, and reflected in reimbursement outcomes.

The AVP serves as the enterprise subject matter expert for payer contract performance and compliance and works collaboratively with Managed Care Contracting, Revenue Cycle, Finance, Compliance, Legal, Patient Financial Services, Physician Enterprise, Faculty Practice, Clinical Operations, Information Technology, Data & Analytics, and other stakeholders.

The role is responsible for identifying and quantifying contract-performance opportunities and risks, monitoring actual versus expected reimbursement, establishing appropriate controls and escalation mechanisms, and driving resolution of material reimbursement variances.

The AVP will develop and mature an enterprise Contract Compliance & Performance function that integrates contractual knowledge, reimbursement analytics, operational controls, data intelligence, and cross-functional accountability to improve financial performance, strengthen contractual compliance, and reduce revenue leakage and financial risk.

Responsibilities

Essential Responsibilities

1. Enterprise Contract Compliance & Performance

• Develop and execute the enterprise strategy for payer contract compliance and performance.
• Establish governance, accountability, and standardized processes for monitoring compliance with payer contract terms.
• Serve as the enterprise subject matter expert on the operational interpretation and implementation of payer contract provisions.
• Establish standards for monitoring contractual reimbursement, payment accuracy, contractual obligations, and payer performance.
• Develop mechanisms to identify, quantify, prioritize, and resolve material variances between contracted and actual reimbursement.
• Establish appropriate escalation processes for significant contract compliance issues, systemic payment variances, and material financial risk.
• Provide executive leadership with clear, actionable intelligence regarding payer performance, contractual risk, reimbursement trends, and financial opportunity.
• Develop a continuous-improvement framework to strengthen contract performance and reduce recurring reimbursement variance.
• Support organizational growth, affiliations, acquisitions, joint ventures, and new business arrangements by assessing contract-performance and reimbursement implications.

2. Contract Operationalization

Provide enterprise oversight for translating negotiated payer agreements, amendments, and reimbursement methodologies into operational and system requirements.

Responsibilities include:

• Interpret complex payer contract provisions and translate them into operational and system requirements.
• Establish governance for contract implementation, configuration, testing, validation, and ongoing maintenance.
• Partner with Managed Care, Revenue Cycle, Finance, Information Technology, and operational leaders to ensure accurate implementation of contracted terms.
• Provide oversight of contract modeling, fee schedules, reimbursement rules, payment logic, and related system configurations.
• Establish pre-implementation and post-implementation validation processes.
• Monitor timely implementation of new contracts, amendments, rate changes, escalators, and other contractual provisions.
• Identify and escalate implementation discrepancies that may result in financial loss or compliance risk.
• Establish standardized documentation of contract interpretations, assumptions, requirements, and implementation decisions.
• Ensure changes to contractual terms are appropriately communicated to affected stakeholders and incorporated into applicable operational processes.

3. Reimbursement Performance & Payment Validation

Lead enterprise efforts to determine whether actual payer reimbursement aligns with contractual expectations.

Responsibilities include:

• Establish methodologies for calculating expected reimbursement and identifying payment variances.
• Monitor actual versus expected reimbursement across applicable payer arrangements.
• Identify material underpayments, overpayments, payment variances, and other deviations from contractual expectations.
• Establish processes for prioritizing payment recovery and remediation opportunities.
• Analyze trends in reimbursement variance, denials, contractual adjustments, appeals, and other indicators of payer performance.
• Lead root-cause analysis of material or recurring reimbursement discrepancies.
• Partner with Revenue Cycle and operational leaders to implement sustainable corrective actions.
• Establish controls to monitor the effectiveness of remediation efforts.
• Distinguish isolated payment issues from systemic contract, operational, configuration, data, or payer-performance issues.
• Ensure identified systemic issues are addressed at their source rather than relying solely on retrospective recovery.

4. Managed Care Partnership

Partner strategically with Managed Care leadership to ensure contract-performance intelligence informs payer strategy and negotiations.

Responsibilities include:

• Provide financial and operational analysis to support contract negotiations and renewals.
• Evaluate proposed reimbursement methodologies and contractual changes.
• Identify contract provisions that may create operational, financial, or compliance risk.
• Provide recommendations regarding contract language, reimbursement methodologies, payment provisions, and performance requirements.
• Analyze historical and projected payer performance to inform negotiation strategies.
• Support evaluation of new payer products, alternative payment arrangements, value-based contracts, and other reimbursement models.
• Provide objective performance data and financial intelligence to support payer relationship management.
• Collaborate with Managed Care leadership on escalation of material payer-performance issues.
• Support scenario modeling and financial impact analyses for proposed contractual changes.

5. Analytics & Revenue Intelligence

Establish an enterprise analytics and reporting framework that provides actionable intelligence regarding contract performance and reimbursement.

Develop and maintain reporting and dashboards addressing:

• Contracted versus actual reimbursement
• Payment accuracy
• Contract performance
• Payment variance
• Underpayment and recovery opportunities
• Payer performance
• Denial and appeal trends
• Contract implementation status
• Financial impact of contractual provisions
• Material compliance and performance risks
• Resolution status of identified variances

Responsibilities include:

• Establish standardized definitions, methodologies, and performance measures for contract compliance reporting.
• Partner with Revenue Reporting and Intelligence to integrate contract-performance data with enterprise revenue and financial reporting.
• Develop executive dashboards and payer scorecards.
• Ensure data used for contract-performance analysis is accurate, timely, consistent, and appropriately governed.
• Develop predictive and advanced analytics to identify emerging risks and opportunities.
• Leverage automation and artificial intelligence, where appropriate, to improve monitoring, variance detection, prioritization, and workflow.
• Translate complex reimbursement data into actionable recommendations for executive and operational leaders.

6. Audit, Compliance & Risk Management

Establish a risk-based framework for monitoring compliance with payer contractual obligations and applicable reimbursement requirements.

Responsibilities include:

• Develop risk-based contract compliance monitoring and audit methodologies.
• Establish periodic reviews of high-risk, high-value, or strategically significant contractual provisions.
• Coordinate with Corporate Compliance, Internal Audit, Legal, Finance, Revenue Cycle, and other oversight functions as appropriate.
• Support internal and external audits involving payer reimbursement and contractual compliance.
• Monitor applicable federal and state reimbursement requirements and assess operational implications.
• Ensure contract compliance processes appropriately incorporate applicable Medicare, Medicaid, commercial payer, and state requirements.
• Identify and escalate material contractual, financial, operational, and compliance risks.
• Establish documented corrective-action and remediation processes.
• Maintain appropriate documentation supporting contract interpretations, monitoring activities, findings, and resolutions.

The AVP will work in partnership with, but will not replace, the independent authority of Corporate Compliance, Legal, Internal Audit, or other designated oversight functions.

7. Appeals, Disputes & Recovery

Provide executive oversight for significant payer payment disputes and recovery activities.

Responsibilities include:

• Establish criteria for escalation of significant or high-value payment disputes.
• Oversee complex contractual reimbursement disputes.
• Support resolution of disagreements involving contract interpretation or payment methodology.
• Monitor recovery activity, outcomes, and trends.
• Partner with Managed Care and Legal on escalated payer disputes.
• Support arbitration, formal dispute resolution, or other escalation processes when appropriate.
• Identify systemic issues underlying recurring disputes and coordinate corrective action.
• Establish reporting on recovery performance, unresolved disputes, and material payer issues.

8. Technology, Data & Systems

Partner with Information Technology, Revenue Cycle technology teams, Data & Analytics, and Revenue Reporting and Intelligence to ensure technology capabilities support contract compliance and performance management.

Provide strategic oversight for capabilities including:

• Contract modeling and management
• Hospital and professional billing systems
• Contract configuration and payment logic
• Expected reimbursement modeling
• Payment variance analytics
• Enterprise data warehouse and reporting
• Automated monitoring and exception identification
• Data visualization and executive reporting
• Advanced analytics and AI-enabled payment validation

Responsibilities include:

• Establish requirements for contract-performance data and analytics.
• Ensure appropriate controls for data quality, system configuration, testing, and change management.
• Participate in system and technology roadmap planning.
• Evaluate emerging technologies that may improve contract monitoring and performance.
• Partner with IT to ensure contract changes are accurately reflected in relevant systems.
• Establish ongoing validation of critical contract-related system configurations and data.

9. Enterprise Governance

Establish and maintain governance structures that support consistent enterprise management of contract compliance and performance.

Responsibilities include:

• Define roles, responsibilities, decision rights, and escalation pathways.
• Establish enterprise standards for contract-performance monitoring.
• Develop governance forums and reporting structures as appropriate.
• Maintain clear interfaces between Contract Compliance & Performance, Managed Care, Revenue Cycle, Finance, Compliance, Legal, and other functions.
• Identify and resolve gaps or duplication in organizational accountability.
• Establish policies, procedures, standards, and controls supporting contract compliance.
• Promote consistent methodologies across hospital and professional environments while accounting for differences in contractual arrangements and operational requirements.

10. Leadership

Reporting to the Vice President of Revenue Reporting and Intelligence, provide strategic leadership for the Contract Compliance & Performance function.

Responsibilities include:

• Develop and execute the strategic roadmap for Contract Compliance & Performance in alignment with the broader Revenue Reporting and Intelligence strategy.
• Establish organizational structure, roles, responsibilities, and decision rights.
• Develop annual operating plans, strategic priorities, and measurable performance objectives.
• Establish executive reporting and performance-management mechanisms.
• Provide regular updates to executive leadership regarding contract performance, material risks, financial opportunities, and remediation.
• Lead enterprise initiatives involving reimbursement analytics, contract performance, financial intelligence, and revenue-cycle transformation.
• Manage departmental budgets, resources, and priorities.
• Recruit, develop, and retain high-performing talent.
• Establish succession planning and workforce development strategies.
• Foster a culture of accountability, collaboration, innovation, and continuous improvement.
• Represent Contract Compliance & Performance on enterprise governance committees and strategic initiatives.
• Serve as a trusted advisor to senior leadership on payer performance and contractual reimbursement matters.

Organizational Leadership

Lead a multidisciplinary team responsible for enterprise Contract Compliance & Performance capabilities, which may include:

• Contract Compliance
• Contract Performance Analytics
• Payment Validation