Director, Payer Relations (Revenue Cycle Management)

Cardinal Health

1d•Remote

About The Position

What Payer Relations & Revenue Cycle Management (RCM) contributes to Cardinal Health Revenue Cycle Management enables Cardinal Health’s patient-facing HME/DME businesses to deliver financially sustainable care by ensuring accurate payer compliance, clean claims submission, denial prevention, and timely cash collection. Within RCM, Payer Relations / Payer Governance leads enterprise-wide payer engagement and issue resolution to reduce reimbursement disruption caused by payer policy variability, complex authorization and documentation requirements, and inconsistent claim adjudication outcomes. This function owns high-impact payer escalations, denial trend remediation, and payer rule governance to ensure payer requirements and contractual terms are accurately operationalized in systems and workflows—protecting revenue, reducing avoidable denials, and improving cash performance across Medicare, Medicaid, Managed Medicaid, Medicare Advantage, and Commercial payers. The Director, Payer Relations (RCM) establishes a centralized leader responsible for leading enterprise-wide payer escalation, denial prevention, and payer rule governance efforts to address systemic payer dysfunction impacting reimbursement, denial trends, and cash performance. This role provides strategic and operational oversight of the Payer Advisors, Senior Analysts (Global Denials / Denials Prevention Task Force), and Payer Rules Advisors, and serves as the senior point of accountability for resolving high-dollar payer issues, preventing repeat denials, and ensuring payer requirements are fully operationalized across the revenue cycle. This Director also serves as the senior escalation authority for complex payer issues and is accountable for ensuring payer contract terms and requirements are accurately executed within systems, workflows, and operational processes to minimize reimbursement risk. Location - Fully remote, open to candidates nationwide (with preference towards individuals willing and able to travel up to 25%)

Requirements

Ideally targeting individuals who bring 10+ years of experience in payer relations, managed care, revenue cycle, healthcare finance, or regulatory affairs (with demonstrated success resolving high-dollar payer issues), strongly preferred.
Prior leadership experience overseeing payer relations, revenue cycle, or policy governance teams, strongly preferred.
Direct experience leading escalations with health plan Provider Relations leadership and engaging regulatory bodies (e.g., CMS) to resolve reimbursement and compliance disputes, strongly preferred.
Strong working knowledge of payer contracts, CMS regulations, and escalation mechanisms.
Proven ability to lead cross-functional teams and influence executive stakeholders in a complex, multi-entity environment.
Highly analytical, with experience leveraging data to support payer negotiations, denial prevention, and performance improvement.

Responsibilities

Provide strategic and operational leadership across the Payer Advisors, Senior Analysts (Global Denials), and Payer Rules Advisors, ensuring alignment between payer escalations, denial prevention efforts, and payer rule execution across ADSG (Advanced Diabetes Supply Group), US MED, and Edgepark.
Own the enterprise payer escalation and denial prevention strategy, including prioritization of high-risk payer issues, standardized escalation frameworks, and executive-level engagement with health plan Provider Relations and payer leadership.
Build and maintain strong, executive-level relationships with health plan Provider Relations leadership and key payer stakeholders to proactively resolve systemic issues and reduce downstream reimbursement risk.
Serve as the final escalation point for complex, unresolved payer issues originating from claims, billing, contracting, or AR teams, mediating disputes and driving resolution in alignment with contractual, regulatory, and compliance requirements.
Oversee the stand-up and execution of the Denials Prevention Task Force, ensuring enhanced ATB and enterprise analytics are leveraged to identify upstream risk, quantify financial exposure, and drive systemic remediation.
Lead fact-based payer engagement, negotiation, and settlement efforts by leveraging enterprise data and analytics to resolve reimbursement delays and recover material dollars at risk.
Partner closely with AR Directors to ensure all receivables impacted by payer escalations, disputes, and settlements are accurately identified, flagged, tracked, and actively managed within AR.
Collaborate with Market Access, Legal, Compliance, Finance, and Operations teams to ensure payer contract terms, conditions, and requirements are accurately operationalized within billing systems, workflows, and payer configurations to prevent avoidable denials.
Provide strategic input and analytical support to payer contract negotiations by identifying historical denial patterns, operational risks, and reimbursement impacts to ensure negotiated terms are executable and aligned with financial objectives.
Establish governance, reporting, and key performance indicators (KPIs) across payer issues, denial prevention, and payer rule execution to ensure transparency, accountability, and sustained improvement.
Serve as the executive liaison across Revenue Cycle, IT/Data, Finance, and external payers to ensure payer outcomes are translated into operational and financial results.
Bring direct, hands-on experience leading escalations with health plan leadership and navigating regulatory and legal escalation pathways, including engagement with CMS and other oversight agencies, to resolve systemic payer issues and enforce payer field accountability.