Maintain expertise in payer policies and reimbursement methodologies.
Lead efforts to address claim denial drivers and implement resolutions.
Benefits
Comprehensive healthcare coverage for employees and families.
Retirement savings plan with employer match.
Professional development and training opportunities.
Flexible work arrangements to support work-life balance.
Employee wellness programs and resources.
Full Job Description
Position Summary: The Director of Payer Accountability & Reimbursement Performance provides enterprise leadership to ensure Hartford HealthCare receives timely, accurate, and compliant reimbursement for all covered services. The Director is responsible for monitoring payer performance, analyzing systemic denial and underpayment trends, and leading payer accountability and escalation strategies across the organization.The Director works closely across Revenue Cycle Operations, Reporting & Analytics, Managed Care, Finance, Legal, and ITS and Optimization teams to protect revenue integrity, promote operational excellence, and ensure payer accountability to expected reimbursement and timely resolution of issues. Key Accountabilities:
Leads enterprise-wide payer performance management in partnership with Revenue Cycle Operations, Reporting & Analytics, and Managed Care, serving as the primary point of accountability for identifying, prioritizing, and resolving payer issues and escalations
Owns and leads the enterprise payer accountability and escalation framework serving as the central escalation authority for egregious payer behavior, disputes, and potential legal action. Partnering with Legal to develop and present data-driven documentation supporting payer accountability efforts
Directs the ongoing analysis of denial reports, accounts receivable aging, and underpayment trends to proactively identify systemic payer risks, reimbursement leakage, and enterprise recovery opportunities
Provides strategic oversight of payer performance reporting and analytics, ensuring timely, accurate, and actionable insights to support decision-making, escalation prioritization, and executive transparency
Develops and drives non-transactional, trend-based payer engagement strategies designed to improve payer performance, accelerate issue resolution, and optimize reimbursement outcomes at the enterprise level
Maintain executive-level expertise in payer policies, contract terms, reimbursement methodologies, and regulatory requirements, assessing enterprise impact and advising leadership on financial, operational, and compliance implications
Leads enterprise efforts to identify and address claim denial drivers related to contract configuration, documentation, and coverage gaps; direct cross-functional collaboration to implement sustainable resolution and optimization strategies
Establishes and enforces governance structures, accountability standards, and performance tracking mechanisms
Champions compliant reimbursement, ethical revenue integrity practices, and continuous improvement while influencing outcomes across a complex, matrixed organization
Qualifications:
Bachelor's degree in business, healthcare or a related field is required
Seven plus years of progressive experience in Revenue Cycle, Managed Care, Payer Reimbursement, or healthcare financial operations
Five plus years of leadership experience demonstrating the ability to navigate cross-functional initiatives and executive-level partnerships
Expert knowledge of payer contracts, reimbursement methodologies, and payer policy interpretation
Strong understanding of hospital and physician billing workflows, claim lifecycle processes, denial patterns, and underpayment reviews
Demonstrated knowledge of CPT, HCPCS, ICD-10, healthcare documentation standards, billing requirements, and applicable federal and state regulations
Advanced proficiency with Epic EMR and revenue cycle reporting tools
Advanced skills in Microsoft Office (Excel, PowerPoint, Word, Outlook, Access) with the ability to create executive-level analyses and presentations
Exceptional analytical, critical-thinking, and problem-solving skills
Strong project management and organizational abilities
Excellent written, verbal, and presentation skills with the ability to communicate complex concepts clearly
Proven ability to lead across cross-functional stakeholders in a large, matrixed healthcare environment
Professional integrity, sound judgment, and accountability consistent with Hartford HealthCare values
