Senior Vice President, Revenue and Payor Relations

Description

Position Summary:

The Senior Vice President of Revenue & Payor Relations provides strategic and operational leadership for all revenue-generating and revenue-management functions across MaineHealth. This executive role is responsible for the direction and performance of the system's revenue cycle operations, payor contracting, and reimbursement strategy, with a focus on financial sustainability, and alignment with clinical and operational priorities. The Senior Vice President of Revenue & Payor Relations works collaboratively with finance, clinical, operational, IT and government relations leaders to optimize cash flow, ensure regulatory compliance, and support the system's long-term strategic goals.

Required Minimum Knowledge, Skills, and Abilities (KSAs):

1. Education: Master's degree in Accounting, Finance, Business Administration, Healthcare Administration, or a related field strongly preferred.

2. Experience: Minimum of 10 years of progressive leadership experience in healthcare revenue cycle management, payor contracting, or reimbursement, with at least 5 years in a senior executive role.

3. Additional Skills/Requirements Required: Expertise in managed care, value-based payment models, and healthcare financial regulations.

4. Expertise in managed care, value-based payment models, and healthcare financial regulations.

5. Demonstrated success leading complex system-wide initiatives that improve financial performance and operational efficiency.

6. Proven ability to lead high-performing teams, manage vendor relationships, and collaborate across departments and disciplines.

7. Experience in a multi-entity, integrated health system or academic medical center.

8. Familiarity with Epic or equivalent EHR/revenue cycle platforms.

Essential Functions:

* Collaborate with the CFO and other senior executives to develop and execute an ongoing integrated strategic and operational plan to modernize the health system's payer contracting strategy an ensure proper alignment with revenue cycle management to increase revenue collections and cash generation.

* Provide thought leadership to anticipate market trends, payment reform, and regulatory changes impacting reimbursement and financial operations.

* Lead the design and implementation of scalable, technology led processes and infrastructure across the system to support efficient revenue cycle performance and alignment with enterprise priorities.

* Drive cross-functional collaboration and communication among internal stakeholders to streamline workflows, reduce redundancy, and foster accountability.

Revenue Cycle Management

* Provide executive oversight of end-to-end revenue cycle functions, including patient access, authorization, charge capture, coding, billing, collections, and denials management.

* Establish and monitor standardized revenue cycle performance metrics across the system to ensure financial targets are met or exceeded.

* Lead enterprise-wide initiatives to optimize yield, reduce days in A/R, improve clean claim rates, and lower cost-to-collect.

* Implement and champion enterprise revenue integrity programs to ensure appropriate and accurate coding, documentation, and charge capture.

* Assess and optimize revenue cycle technologies, automation opportunities, and analytics tools to drive performance improvement.

* Guide business continuity planning and operational readiness strategies to support member organizations during leadership transitions or crises.

Payor Contracting

* Serve as the co-lead in contract negotiations with commercial, Medicare Advantage, and Medicaid managed care plans.

* Analyze contract performance and recommend changes in negotiation strategy to maximize reimbursement within the regulatory framework and payer contracts and support financial sustainability.

* Establish contract modeling tools and analytics frameworks to evaluate payment terms, rate structures, and value-based incentive opportunities.

* Build and maintain effective relationships with key payor executives to ensure transparency, collaboration, and dispute resolution.

* Collaborate with legal, compliance, and clinical operations to ensure contract language and reimbursement terms align with regulatory standards and clinical practices.

* Lead annual payor strategy reviews to align contracting priorities with system goals for access, affordability, and margin improvement.

Reimbursement Management

* Ensure optimal performance under governmental programs such as Medicare, Medicaid, and emerging payment models (e.g., ACO, DSRIP, CMMI pilots).

* Conduct reimbursement impact modeling for strategic initiatives, such as service line expansions or site-of-care shifts.

* Partner with finance and analytics teams to forecast net revenue by payor and service line, including regulatory and market trend assumptions.

* Lead internal education efforts on reimbursement policy changes affecting clinical or operational teams.

Information Technology & Systems Integration

* Partner with the CIO and IT teams to identify and implement long-term infrastructure solutions for revenue cycle management, including the adaption of automation and artificial intelligence.

* Align revenue cycle operations with enterprise data systems (e.g., EHR, ERP) to ensure real-time visibility into financial performance.

* Optimize business performance by enhancing alignment between operational workflows and technology capabilities.

Compliance & Internal Controls

* Ensure compliance with federal and state laws, third-party payor requirements, and accreditation standards (e.g., The Joint Commission) related to billing, documentation, and access.

* Establish and monitor internal controls to ensure integrity of revenue recognition and financial reporting.

* Develop risk mitigation strategies for audit, denial management, and documentation compliance across the system.