Head of Payments

Head of Payments

JOB DESCRIPTION

Job Title: Head of Payments

Position Type: Full Time

Work Setting: Hybrid

Department: Executive Committee

Reports to: Chief Operating Officer

FLSA: Salary, Exempt

THE POSITION

The Head of Payments will report into VaxCare's Chief Operating Officer (COO). This role is responsible for ensuring VaxCare converts healthcare services delivered into accurate, timely, and predictable payment. This executive will lead two highly interconnected capabilities:

• Revenue Cycle Management (RCM) - owning the end-to-end revenue cycle and continuously improving VaxCare's ability to submit clean claims, resolve denials, collect reimbursement, accelerate cash flow, and reduce bad debt and cost to collect.
• Payer Contract Operations - owning the operationalization of payer contracts after contracting terms have been established, ensuring payer agreements are translated accurately and consistently into the systems, workflows, credentialing, reimbursement logic, and operating processes required for RCM to perform with excellence.

The Head of Payments will create an integrated operating model connecting payer contract requirements to the actual journey of a claim, from contract implementation and provider credentialing through claim submission, adjudication, payment, issue resolution, and collection.

Strong payer contracts only create value when they are operationalized effectively. As VaxCare continues to scale, increasing complexity across payer requirements, credentialing, reimbursement rules, claims workflows, and billing systems creates both financial opportunity and operational risk. The Head of Payments will own the operating system that connects payer contract requirements to revenue realization. This leader will ensure that:

VaxCare's RCM mandate is unique in the market: the organization manages 600-700 payer contracts across a very high volume of low-dollar claims, where every penny matters. This role requires direct experience operating RCM at that scale and within that model.

• Contract terms are translated correctly into operational workflows.
• Providers and VaxCare entities are properly credentialed and maintained with payers.
• Payer-specific billing and reimbursement requirements are understood and configured.
• RCM teams have the information, tools, and workflows required to submit and resolve claims effectively.
• Contract-related payment issues are identified, escalated, root-caused, and permanently resolved.
• Claims and payment data create a feedback loop to identify operational, payer, product, or contracting opportunities.

The objective is simple: maximize the percentage of earned revenue that VaxCare collects while making the payment process increasingly scalable, predictable, and efficient.

Role Mandate

• Revenue Cycle Excellence: Own VaxCare's end-to-end revenue cycle performance and continuously improve cash yield, predictability, scalability, and cost efficiency.
• Payer Contract Operations: Build the operational capability that takes executed payer contracts and translates them into accurate system configuration, credentialing, reimbursement rules, billing workflows, and operating procedures.
• Contract-to-Cash Integration: Create a seamless operating model connecting payer requirements, contract terms, eligibility, claims submission, adjudication, payment, denials, and collections.
• Payer Issue Resolution: Build disciplined processes to rapidly identify, prioritize, escalate, and permanently resolve payer-related issues affecting payment.
• Revenue Integrity: Ensure VaxCare is reimbursed accurately and appropriately under contracted terms and identify systemic underpayments, configuration issues, or other revenue leakage.
• Data, Technology & Automation: Modernize Payments through analytics, automation, AI, workflow redesign, and scalable technology.
• Executive Leadership: Operate as an enterprise leader, working across Operations, Finance, Product, Technology, Market Access, Partner Success, and Commercial teams.

ESSENTIAL RESPONSIBILITIES

Revenue Cycle Management

• Lead the teams responsible for billing, claims processing, payment posting, denials, appeals, collections, revenue integrity, and revenue-cycle analytics.
• Improve first-pass payment performance and reduce preventable denials.
• Reduce bad debt and Days Sales Outstanding while improving overall net collections.
• Improve employee productivity and reduce cost to collect through workflow redesign and automation.
• Develop disciplined denial prevention and recovery programs.
• Establish standardized operating processes, service levels, controls, and performance management across RCM.
• Build an operating culture focused on root-cause resolution rather than repeated manual intervention.
• Partner with Product and Technology to improve billing platforms, claims workflows, automation, and decision-support capabilities.

Payer Contract Operations

• Own the operational implementation of payer contracts after contracting is complete.
• Translate payer agreements and requirements into clear operational and system requirements.
• Ensure reimbursement terms, fee schedules, billing requirements, claims rules, and payer-specific requirements are accurately reflected in VaxCare workflows and systems.
• Own payer and provider credentialing, recredentialing, enrollment, recertification, and ongoing provider maintenance required to maintain reimbursement.
• Build standardized processes and controls for implementing new payer contracts and material contract amendments.
• Maintain a centralized operational understanding of payer requirements and ensure changes are communicated and implemented across RCM, Product, Technology, Partner Success, and other affected teams.
• Create readiness processes so new contracts or payer changes are fully operational before they affect claims.
• Identify contract configuration or payer-operational issues contributing to denials, underpayments, delayed payment, or bad debt.
• Establish clear ownership and escalation paths for payer-related operational issues.
• Partner closely with Market Access to provide data and operational insights that inform payer discussions, while Market Access retains responsibility for payer strategy and contract negotiation.
• Work hand-in-hand with the Head of Network to drive insights, needs, and relationships with payers through Joint Operating Committees (JOCs).

Contract-to-Cash Performance

• Create an integrated view of performance from executed contract through final payment.
• Establish feedback loops between RCM performance and Payer Contract Operations.
• Identify systemic revenue leakage and lead cross-functional efforts to eliminate root causes.
• Use claims and reimbursement data to identify recurring payer, contract, system, workflow, or provider-maintenance issues.
• Ensure payer-specific operational knowledge is institutionalized rather than dependent on individual expertise.

Continuous Improvement, Technology & Automation

• Develop the multi-year Payments operating and technology roadmap.
• Drive automation of repetitive and rules-based activities.
• Partner with Product and Technology to build scalable solutions that reduce manual claim intervention.
• Apply analytics and AI to improve claim quality, denial prevention, workflow prioritization, and payer issue identification.
• Continually simplify workflows as the business scales.

People Leadership

• Assess the current team's talent and capabilities, and develop a perspective on the roles and skills needed to scale the function.
• Recruit, develop, and retain exceptional leaders across RCM and Payer Contract Operations.
• Build clear organizational accountability and decision rights.
• Develop deep healthcare payment and payer-operational expertise across the organization.
• Create a culture of urgency, accountability, continuous improvement, and measurable outcomes.

Key Performance Measures

The Head of Payments will be accountable for a focused set of enterprise payment metrics, including:

• Net Collection Rate
• Bad Debt
• Days Sales Outstanding
• Cost to Collect
• First-Pass Paid Rate
• Untouched Paid Claim Rate
• Denial Rate
• Claims requiring manual intervention
• Payer-related denial rate
• Contract implementation accuracy and timeliness
• Credentialing / recredentialing accuracy and timeliness
• Payer issue resolution time
• Contracted reimbursement realization / underpayment

• Productivity and automation

REQUIRED EXPERIENCE & QUALIFICATIONS

VaxCare is seeking an experienced revenue cycle and payer operations executive who brings:

• This role will be based in Orlando, Florida, and working out of VaxCare's headquarters, or willing to travel to Orlando on a weekly basis.
• 15+ years of progressive leadership experience in Revenue Cycle Management, payer operations, reimbursement operations, healthcare payments, or related healthcare operating roles.
• Significant experience leading complex, scaled Revenue Cycle organizations.
• Deep understanding of the healthcare claims lifecycle, including eligibility, billing, claims submission, adjudication, payment posting, denials, appeals, collections, and revenue integrity.
• Strong understanding of payer contracts and demonstrated ability to translate contractual requirements into operational processes and systems.
• Experience with payer enrollment, credentialing, provider maintenance, reimbursement configuration, and payer issue resolution.
• Demonstrated ability to identify and eliminate systemic revenue leakage.
• Track record of using data, technology, automation, and process improvement to materially improve RCM performance.
• Proven ability to lead large teams and develop strong senior leaders.
• Strong executive communication and cross-functional leadership skills.
• Ability to operate effectively across Operations, Finance, Product, Technology, and payer-facing functions.
• Experience operating Revenue Cycle Management at scale within a high-contract-count, high-volume, low-dollar-claim model, where margin discipline and cost-to-collect are critical.
• Experience working in RCM within ancillary healthcare businesses operating at national scale is a plus.

Leadership Profile

• An exceptional operator who understands that strong strategy only matters when it translates into reliable execution.
• End-to-end oriented, connecting contract requirements, systems, workflows, claims, and payment rather than optimizing individual silos.
• Data-driven, using performance data to identify root causes and prioritize the highest-value opportunities.
• Systems-minded, building processes that prevent problems rather than organizations that become excellent at fixing the same problems repeatedly.
• Technologically forward, aggressively pursuing automation and scalable solutions.
• Highly accountable, with a strong ownership mentality for financial outcomes.
• A strong cross-functional leader capable of aligning teams across organizational boundaries.
• A talent builder who develops leaders and creates high-performing organizations.

Setting Strategy

The ability to create and articulate an inspiring vision for the organization, not only for the areas they are directly responsible for, but the enterprise as a whole. The inclination to seek and analyze data from a variety of sources to support decisions and to align others with the organization's overall st