Job Description

Senior Director, Contract Compliance & Performance

The Senior Director, Contract Compliance & Performance is a senior operational and analytical leader responsible for executing the enterprise Contract Compliance & Performance strategy under the direction of the Associate Vice President, Contract Compliance & Performance.

The Senior Director leads the day-to-day monitoring, analysis, validation, and remediation of payer contract performance across the health system, including hospital, ambulatory, physician, and faculty practice operations.

The position translates payer contract requirements into measurable operational controls, reimbursement analytics, monitoring processes, and actionable performance intelligence. The Senior Director is responsible for identifying discrepancies between contracted and actual reimbursement, quantifying financial impact, coordinating root-cause analysis, and driving resolution of contract-performance issues.

Working in close partnership with Managed Care Contracting, Revenue Cycle, Finance, Patient Financial Services, Physician Enterprise, Faculty Practice, Information Technology, Data & Analytics, Compliance, Legal, and operational leadership, the Senior Director ensures that contract-performance issues are identified early, appropriately escalated, and resolved through sustainable corrective and preventive actions.

The Senior Director serves as a key deputy to the AVP and provides leadership for the operational execution and maturation of the Contract Compliance & Performance function.

Responsibilities

Essential Responsibilities

1. Contract Compliance & Performance Operations

Execute the enterprise Contract Compliance & Performance framework established by the AVP.

Responsibilities include:

• Lead day-to-day operations of the Contract Compliance & Performance function.
• Implement standardized processes for monitoring payer contract compliance and performance.
• Monitor contractual reimbursement, payment accuracy, contractual obligations, and payer performance.
• Identify, quantify, and prioritize material reimbursement variances.
• Establish work plans for investigating and resolving identified contract-performance issues.
• Maintain appropriate tracking of identified issues, financial exposure, corrective actions, owners, and resolution status.
• Escalate significant contractual, financial, operational, or compliance risks to the AVP.
• Provide regular performance updates, trend analysis, and recommendations to the AVP.
• Support development and implementation of enterprise contract-performance standards.
• Identify opportunities to improve monitoring processes, controls, analytics, and operational workflows.
• Ensure consistent application of Contract Compliance & Performance methodologies across hospital and professional environments.

2. Contract Operationalization & Implementation

Support the AVP in ensuring negotiated payer agreements and amendments are accurately translated into operational and system requirements.

Responsibilities include:

• Review payer contracts, amendments, rate changes, and reimbursement provisions for operational implications.
• Translate contractual requirements into documented business, operational, and analytical requirements.
• Partner with Managed Care, Revenue Cycle, IT, Finance, and operational teams on contract implementation.
• Participate in contract configuration, testing, validation, and implementation activities.
• Validate that reimbursement methodologies, fee schedules, rates, escalators, and payment provisions are appropriately reflected in applicable systems.
• Establish and maintain implementation checklists and validation protocols.
• Conduct post-implementation testing to identify discrepancies between contractual requirements and operational/system outcomes.
• Track implementation issues through resolution.
• Maintain documentation of contract interpretations, assumptions, requirements, testing results, and implementation decisions.
• Ensure amendments and rate changes are incorporated into monitoring and validation processes in a timely manner.
• Escalate implementation risks or delays that may result in financial loss or contractual noncompliance.

3. Reimbursement Analytics & Payment Validation

Lead operational execution of methodologies designed to determine whether payer reimbursement aligns with contractual expectations.

Responsibilities include:

• Oversee development and execution of expected reimbursement methodologies.
• Analyze actual versus expected reimbursement across applicable payer arrangements.
• Identify underpayments, overpayments, payment variances, and other deviations from contractual expectations.
• Quantify financial impact associated with identified reimbursement discrepancies.
• Establish and maintain prioritization methodologies based on financial value, frequency, risk, payer significance, and operational impact.
• Conduct detailed analysis of payment variance trends.
• Identify patterns associated with payer behavior, billing processes, system configuration, coding, contractual interpretation, or other root causes.
• Distinguish isolated payment discrepancies from systemic issues.
• Develop recurring monitoring processes for high-risk reimbursement provisions.
• Partner with Revenue Cycle and operational teams to validate findings and implement corrective action.
• Monitor remediation results to determine whether identified issues have been sustainably resolved.
• Provide analytical support for recovery and dispute activities.

4. Contract Performance Monitoring

Develop and maintain ongoing monitoring of payer contract performance.

Responsibilities include:

• Establish recurring monitoring schedules for high-value and high-risk contractual provisions.
• Monitor payer reimbursement performance against contractual expectations.
• Develop payer-specific and contract-specific performance profiles.
• Identify emerging payment trends and areas of financial opportunity or risk.
• Monitor the financial impact of reimbursement methodologies, contractual provisions, rate changes, and payment policies.
• Develop exception-based monitoring to focus resources on material issues.
• Establish thresholds for investigation and escalation in partnership with the AVP.
• Track unresolved issues and aging of remediation activities.
• Provide periodic reporting on contract-performance trends.
• Recommend enhancements to monitoring methodologies based on emerging risks and organizational priorities.

5. Analytics, Reporting & Revenue Intelligence

Lead development and maintenance of operational reporting supporting Contract Compliance & Performance.

Reporting may include:

• Contracted versus actual reimbursement
• Payment accuracy
• Payment variance
• Underpayment opportunities
• Recovery performance
• Payer performance
• Contract implementation status
• Contractual rate and methodology changes
• Denial and appeal trends
• Material contract-performance risks
• Open remediation activities
• Financial impact of identified issues

Responsibilities include:

• Establish and maintain standardized reporting methodologies.
• Partner with Revenue Reporting and Intelligence and Data & Analytics to ensure accurate and reliable data.
• Develop dashboards, reports, payer scorecards, and management tools.
• Translate analytical findings into actionable recommendations.
• Validate data used in contract-performance reporting.
• Establish quality-control processes for critical reports and analytics.
• Identify opportunities for automation and exception-based reporting.
• Support development of predictive and advanced analytics.
• Evaluate opportunities to use artificial intelligence and automation to improve payment validation, variance detection, and prioritization.
• Ensure reporting aligns with enterprise definitions and methodologies established by the AVP.

6. Root-Cause Analysis & Corrective Action

Lead structured investigation of material and recurring contract-performance issues.

Responsibilities include:

• Conduct root-cause analysis of reimbursement discrepancies.
• Determine whether issues originate from contractual interpretation, payer behavior, billing, coding, system configuration, data, workflow, or other operational factors.
• Coordinate cross-functional investigation of systemic issues.
• Develop corrective and preventive action plans.
• Establish clear ownership, milestones, and expected outcomes for remediation activities.
• Monitor corrective actions through completion.
• Validate that corrective actions have produced the intended financial and operational results.
• Identify recurring issues requiring enterprise-level intervention.
• Escalate unresolved or systemic issues to the AVP.
• Recommend changes to processes, controls, system configuration, or contractual monitoring based on findings.

7. Appeals, Disputes & Recovery Support

Provide operational leadership and analytical support for significant payer payment disputes and recovery opportunities.

Responsibilities include:

• Identify and prioritize payment recovery opportunities.
• Support development of documentation and analytical evidence for contractual disputes.
• Analyze disputed claims and reimbursement methodologies.
• Coordinate with Revenue Cycle and Managed Care on recovery activities.
• Monitor recovery performance and outstanding payer issues.
• Track disputes by financial value, payer, issue type, age, and resolution status.
• Identify recurring disputes that may indicate systemic contract-performance problems.
• Escalate significant disputes to the AVP and appropriate Managed Care or Legal leadership.
• Support formal dispute resolution, arbitration, or other escalation activities when requested.
• Evaluate the effectiveness of recovery strategies and recommend process improvements.

8. Managed Care & Payer Partnership

Support the AVP and Managed Care leadership with contract-performance intelligence.

Responsibilities include:

• Provide payer-performance analysis to support contract negotiations and renewals.
• Prepare historical reimbursement and performance analyses.
• Analyze proposed reimbursement methodologies and contractual changes.
• Identify provisions that may create operational or financial risk.
• Develop financial impact analyses and scenario models.
• Provide data supporting payer performance discussions.
• Monitor performance against negotiated expectations.
• Identify payer trends that may require strategic attention.
• Support escalation of significant payer-performance concerns.
• Translate operational findings into actionable information for Managed Care leadership.

9. Audit, Compliance & Risk Monitoring

Support the AVP in maintaining a risk-based contract compliance monitoring program.

Responsibilities include:

• Conduct periodic reviews of high-risk or high-value contractual provisions.
• Execute monitoring activities in accordance with established compliance methodologies.
• Maintain documentation supporting monitoring activities, findings, and remediation.
• Coordinate with Corporate Compliance, Internal Audit, Legal, Finance, and other oversight functions as appropriate.
• Support internal and external audits involving payer reimbursement.
• Identify potential contractual, financial, operational, or compliance risks.
• Escalate material findings in accordance with established governance protocols.
• Track corrective actions associated with audit or monitoring findings.
• Support assessment of applicable Medicare, Medicaid, commercial payer, and state reimbursement requirements.
• Maintain appropriate evidence supporting contract-performance conclusions.

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

10. Technology, Systems & Data Management

Partner with IT, Revenue Cycle technology teams, Data & Analytics, and Revenue Reporting and Intelligence to support contract-performance capabilities.

Responsibilities include:

• Define and document business requirements for contract-performance analytics and monitoring.
• Participate in system enhancement and technology roadmap initiatives.
• Support development and validation of contract modeling and reimbursement tools.
• Participate in testing of contract configuration and payment logic.
• Validate system changes associated with payer contracts and amendments.
• Identify data-quality issues affecting contract-performance analytics.
• Establish appropriate quality controls for critical contract-performance data.
• Support automation of payment validation and variance detection.
• Evaluate technology solutions that improve contract monitoring and reimbursement intelligence.
• Participate in implementation and optimization of tools supporting contract compliance.

11. Enterprise Governance & Process Management

Support the AVP in maintaining effective enterprise governance for Contract Compliance & Performance.

Responsibilities include:

• Implement policies, procedures, standards, and controls established for the function.
• Maintain clear documentation of roles, responsibilities, decision rights, and escalation pathways.
• Coordinate governance activities involving Contract Compliance & Performance and related functions.
• Prepare materials for governance committees and executive reviews.
• Track decisions, action items, risks, and remediation activities.
• Identify gaps or duplication among Contract Compliance & Performance, Managed Care, Revenue Cycle, Finance, Compliance, and