Director of Payer Relations and Revenue Cycle Management
Cardinal Health, Indianapolis, Indiana, us, 46262
Overview of Payer Relations & Revenue Cycle Management (RCM) at Cardinal Health
Revenue Cycle Management is crucial for enabling Cardinal Health's patient-facing HME/DME businesses to deliver financially sustainable care. This includes ensuring accurate payer compliance, efficient claim submissions, denial prevention, and timely cash collection. Within RCM, our Payer Relations function leads the charge in enterprise-wide payer engagement and issue resolution, addressing reimbursement disruptions caused by varying payer policies, complex authorization, documentation requirements, and inconsistent claim adjudication outcomes. We own high-impact payer escalations, denial trend remediation, and governance to ensure compliance requirements are effectively operationalized, safeguarding revenue and improving cash performance across diverse payers.
The
Director of Payer Relations (RCM)
plays a pivotal role in leading centralized efforts for payer escalation, denial prevention, and governance, directly addressing systemic issues affecting reimbursement and cash flow. This position offers both strategic and operational oversight of the Payer Advisors, Senior Analysts, and Payer Rules Advisors, serving as the primary authority for resolving complex, high-dollar payer challenges, and ensuring operational alignment with payer requirements. This Director also acts as the senior escalation authority for intricate payer issues, ensuring contractual terms and requirements are accurately implemented in operational processes to minimize financial risk. Key Responsibilities Provide leadership and strategic guidance across teams, aligning efforts in payer escalations, denial prevention, and execution of payer rules.
Own the strategy for enterprise payer escalations and denial prevention, prioritizing high-risk issues and engaging with health plan Provider Relations leadership.
Foster strong executive-level relationships with health plan and payer stakeholders to proactively address systemic issues and minimize reimbursement risk.
Serve as the final escalation point for unresolved payer issues from claims, billing, or contracting teams, mediating conflict and driving resolutions.
Oversee the establishment and execution of the Denials Prevention Task Force, using enhanced analytics to identify risk and financial exposure.
Lead negotiations with payers, harnessing enterprise data to resolve reimbursement delays and recover lost revenue.
Collaborate with key teams to ensure accurate operationalization of payer contract terms in billing systems, minimizing avoidable denials.
Contribute to payer contract negotiations by analyzing denial patterns and operational risks to ensure aligned and executable terms.
Establish governance, reporting, and KPIs around payer issues and denial prevention to ensure accountability and continuous improvement.
Act as the executive liaison across various teams to ensure effective translation of payer issues into tangible operational outcomes.
Bring hands-on experience in navigating regulatory frameworks and escalating issues with agencies to resolve systemic payer challenges.
Qualifications A minimum of 10 years in payer relations, managed care, revenue cycle, healthcare finance, or regulatory affairs, with proven success in resolving high-value payer challenges.
Preferably, experience in leading payer relations or policy governance teams.
Direct experience engaging with health plan Provider Relations and regulatory bodies to settle reimbursement disputes is highly preferred.
Strong understanding of payer contracts, CMS regulations, and escalation mechanisms is essential.
Demonstrated ability to influence cross-functional teams and stakeholders in a complex operating environment.
Highly analytical with experience leveraging data for payer negotiations and performance improvements.
Salary Range : $105,600 - $178,750 USD Bonus Eligibility : Yes Benefits:
Cardinal Health offers a variety of programs to support employee health and well-being, including medical, dental, vision coverage, paid time off, health savings accounts, and more. Application Deadline : Anticipated to close on 02/15/2026. We encourage interested candidates to apply as soon as possible. We are an equal opportunity employer, and we welcome applicants from diverse backgrounds, including those who are veterans, have disabilities, or are returning to the workforce. We aim to create an inclusive workplace that values diversity of thought and experience.
Director of Payer Relations (RCM)
plays a pivotal role in leading centralized efforts for payer escalation, denial prevention, and governance, directly addressing systemic issues affecting reimbursement and cash flow. This position offers both strategic and operational oversight of the Payer Advisors, Senior Analysts, and Payer Rules Advisors, serving as the primary authority for resolving complex, high-dollar payer challenges, and ensuring operational alignment with payer requirements. This Director also acts as the senior escalation authority for intricate payer issues, ensuring contractual terms and requirements are accurately implemented in operational processes to minimize financial risk. Key Responsibilities Provide leadership and strategic guidance across teams, aligning efforts in payer escalations, denial prevention, and execution of payer rules.
Own the strategy for enterprise payer escalations and denial prevention, prioritizing high-risk issues and engaging with health plan Provider Relations leadership.
Foster strong executive-level relationships with health plan and payer stakeholders to proactively address systemic issues and minimize reimbursement risk.
Serve as the final escalation point for unresolved payer issues from claims, billing, or contracting teams, mediating conflict and driving resolutions.
Oversee the establishment and execution of the Denials Prevention Task Force, using enhanced analytics to identify risk and financial exposure.
Lead negotiations with payers, harnessing enterprise data to resolve reimbursement delays and recover lost revenue.
Collaborate with key teams to ensure accurate operationalization of payer contract terms in billing systems, minimizing avoidable denials.
Contribute to payer contract negotiations by analyzing denial patterns and operational risks to ensure aligned and executable terms.
Establish governance, reporting, and KPIs around payer issues and denial prevention to ensure accountability and continuous improvement.
Act as the executive liaison across various teams to ensure effective translation of payer issues into tangible operational outcomes.
Bring hands-on experience in navigating regulatory frameworks and escalating issues with agencies to resolve systemic payer challenges.
Qualifications A minimum of 10 years in payer relations, managed care, revenue cycle, healthcare finance, or regulatory affairs, with proven success in resolving high-value payer challenges.
Preferably, experience in leading payer relations or policy governance teams.
Direct experience engaging with health plan Provider Relations and regulatory bodies to settle reimbursement disputes is highly preferred.
Strong understanding of payer contracts, CMS regulations, and escalation mechanisms is essential.
Demonstrated ability to influence cross-functional teams and stakeholders in a complex operating environment.
Highly analytical with experience leveraging data for payer negotiations and performance improvements.
Salary Range : $105,600 - $178,750 USD Bonus Eligibility : Yes Benefits:
Cardinal Health offers a variety of programs to support employee health and well-being, including medical, dental, vision coverage, paid time off, health savings accounts, and more. Application Deadline : Anticipated to close on 02/15/2026. We encourage interested candidates to apply as soon as possible. We are an equal opportunity employer, and we welcome applicants from diverse backgrounds, including those who are veterans, have disabilities, or are returning to the workforce. We aim to create an inclusive workplace that values diversity of thought and experience.