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Director of Health Care Contracting & Revenue Cycle
Job Description
Our client, a well-established Community Health Center in the New York City area, is seeking an experienced Director of Health Care Contracting & Revenue Cycle to lead and optimize revenue operations. This individual will work cross-functionally with Administration, Finance, Clinical Programs, Operations, and Compliance to develop and implement innovative managed care and revenue cycle strategies that enhance patient services, strengthen financial sustainability, and support long-term growth.
The Director will be responsible for negotiating and managing contracts with payers, ensuring compliance with all contractual obligations, and driving financial and operational efficiencies. This role also oversees billing operations, provider credentialing, and revenue cycle management to ensure compliance with industry regulations and best practices.
Key Responsibilities
Revenue Cycle & Billing
- Direct and oversee all aspects of revenue cycle operations to optimize financial performance and patient financial interactions.
- Analyze trends, identify inefficiencies, and implement process improvements to enhance revenue cycle efficiency.
- Manage payer relationships to maximize reimbursement rates and reduce claims denials.
- Oversee the implementation and maintenance of revenue cycle information systems to improve operational effectiveness.
Credentialing
- Establish and enforce standards for credentialing, privileging, and provider enrollment.
- Ensure compliance with regulatory agencies and accreditation requirements.
- Lead the Credentialing Committee and collaborate with internal stakeholders to address and resolve issues.
- Conduct regular audits to ensure adherence to regulatory and compliance standards.
Managed Care
- Oversee the development, negotiation, implementation, and monitoring of managed care agreements to align with business, financial, and compliance objectives.
- Develop and track key performance indicators, revenue forecasts, and utilization metrics.
- Implement strategies to optimize managed care performance, improving patient access, cost efficiency, and regulatory compliance.
- Continuously monitor payer contract performance, financial statements, and utilization data to drive improvements.
Required Qualifications & Competencies
- Bachelor's degree in business administration, accounting, finance, or a related field.
- 7-10 years of experience in healthcare revenue cycle management, including medical staff credentialing and provider enrollment.
- At least 5 years of leadership experience in a similar role.
- In-depth knowledge of CMS (Medicare, Medicaid) and state/federal regulations (NYSDOH, OIG, OMIG, etc.).
- Strong expertise in medical billing, coding, and credentialing standards (The Joint Commission, NCQA, CMS, NYDOH).
- Proficiency in healthcare billing laws, CPT codes, ICD-9/ICD-10, and HIPAA regulations.
- Experience with credentialing software and Electronic Health/Medical Records technology.
- Exceptional leadership, communication, and analytical skills.
Supervisory Responsibilities
- This role oversees teams responsible for managed care, revenue cycle, credentialing, and billing operations.
Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
#LI-VS1
Meet Your Recruiter
Valerie Swatz
Director, Healthcare Recruitment
Valerie Swatz has strong leadership experience in staffing, recruiting, and business development. She is known for her ability to build relationships.
Learn more about Valerie, Tal Healthcare Employee Biography
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Director of Health Care Contracting & Revenue Cycle
Job Description
Our client, a well-established Community Health Center in the New York City area, is seeking an experienced Director of Health Care Contracting & Revenue Cycle to lead and optimize revenue operations. This individual will work cross-functionally with Administration, Finance, Clinical Programs, Operations, and Compliance to develop and implement innovative managed care and revenue cycle strategies that enhance patient services, strengthen financial sustainability, and support long-term growth.
The Director will be responsible for negotiating and managing contracts with payers, ensuring compliance with all contractual obligations, and driving financial and operational efficiencies. This role also oversees billing operations, provider credentialing, and revenue cycle management to ensure compliance with industry regulations and best practices.
Key Responsibilities
Revenue Cycle & Billing
- Direct and oversee all aspects of revenue cycle operations to optimize financial performance and patient financial interactions.
- Analyze trends, identify inefficiencies, and implement process improvements to enhance revenue cycle efficiency.
- Manage payer relationships to maximize reimbursement rates and reduce claims denials.
- Oversee the implementation and maintenance of revenue cycle information systems to improve operational effectiveness.
Credentialing
- Establish and enforce standards for credentialing, privileging, and provider enrollment.
- Ensure compliance with regulatory agencies and accreditation requirements.
- Lead the Credentialing Committee and collaborate with internal stakeholders to address and resolve issues.
- Conduct regular audits to ensure adherence to regulatory and compliance standards.
Managed Care
- Oversee the development, negotiation, implementation, and monitoring of managed care agreements to align with business, financial, and compliance objectives.
- Develop and track key performance indicators, revenue forecasts, and utilization metrics.
- Implement strategies to optimize managed care performance, improving patient access, cost efficiency, and regulatory compliance.
- Continuously monitor payer contract performance, financial statements, and utilization data to drive improvements.
Required Qualifications & Competencies
- Bachelor's degree in business administration, accounting, finance, or a related field.
- 7-10 years of experience in healthcare revenue cycle management, including medical staff credentialing and provider enrollment.
- At least 5 years of leadership experience in a similar role.
- In-depth knowledge of CMS (Medicare, Medicaid) and state/federal regulations (NYSDOH, OIG, OMIG, etc.).
- Strong expertise in medical billing, coding, and credentialing standards (The Joint Commission, NCQA, CMS, NYDOH).
- Proficiency in healthcare billing laws, CPT codes, ICD-9/ICD-10, and HIPAA regulations.
- Experience with credentialing software and Electronic Health/Medical Records technology.
- Exceptional leadership, communication, and analytical skills.
Supervisory Responsibilities
- This role oversees teams responsible for managed care, revenue cycle, credentialing, and billing operations.
#LI-VS1
Meet Your Recruiter
Valerie Swatz
Director, Healthcare Recruitment
Valerie Swatz has strong leadership experience in staffing, recruiting, and business development. She is known for her ability to build relationships.
Learn more about Valerie, Tal Healthcare Employee Biography