Director, Billing and Payer Relations

Who We Are: 

Herself Health is an Advanced Primary Care practice for women 65+ enrolled in Medicare and Medicare Advantage plans. The concept was borne out of a need to significantly improve the delivery and quality of primary care provided to this population and solve common challenges with the delivery of healthcare today, such as long wait times, rushed appointments, and care that is generalized, rather than personalized. We have a focus on women’s issues later in life (bone loss, weight fluctuation, changes in mental, social and emotional health). The concept and development of this company has been led by a successful venture-backed team and board with a well-established record of building “best-in-class” companies. The Twin Cities Metro area of Minneapolis and St Paul, MN is the location for the company’s fist clinical market. 

What We Do: 

At Herself Health, we believe in taking a bold approach to the care of women in their most self-defining years. From their mid 60’s, as they age, women may finally have the luxury of time for self-care, self-reflection, and self-discovery. They often find a renewed purpose in life and can truly tap into the wellspring of wisdom and resilience they have built, allowing them to live their lives as fully as they aspire. We believe that trusted relationships are nurtured through effective communication and a sense of enduring connection. As healthcare providers, we strive to be our patients’ most trusted partners in their unique journeys through life. Our whole-person approach involves caring equally for the mind and body, while staying anchored in the value of “what matters most” to everyone.  

 
We use a team approach to care. As a highly trained and experienced group of professionals, we delight in working closely with each other, our patients, their loved ones, families, and caregivers. We work hard to maximize overall wellness, preserve function, optimize health, and help each woman age with dignity and grace. Our team of experts aims to elevate our patients’ experience of healthcare by providing evidence-based, whole-person, coordinated, timely, cost effective, and values-centric care. We espouse a joyful, respectful, non-discriminatory, and non-judgmental approach to every interaction, whether with our patients or among ourselves. 

About the role: 

The Director, Billing and Payer Relationships is responsible for executing department strategy to retain and increase market access in specific regions by calling on, planning, negotiating, and contracting.  

Core Responsibilities: 

• Implement and manage professional billing and revenue cycle operation to minimize bad debt, improve cash flow and effectively manage accounts receivable by managing both 3rd party and internal billing resources 
• Manage credential verification, licensure, and payer enrollment process for Herself Health providers and clinics 
• Manage relationships with billing, revenue cycle, and credentialing vendors, as appropriate 
• Coordinate effective management of revenue cycle activities across the organization to include, but not limited to front desk operations, billing, collections, financial counseling for patients, and staff training 
• Compile and prepare data and reporting related to collections, bad debt, patient accounts, accounts receivable, and process integrity 
• Develop and implement comprehensive medical coding education and auditing processes and procedures in collaboration with providers, clinic staff, and operational teams 
• Lead the development and implementation of formalized payer relations and network strategy encompassing both local and national relationships 
• Own end-to-end health plan contracting process, including contract negotiations and partnership launches 
• Collaborate cross-functionally with Operations, Growth, Clinical and Product teams to ensure alignment, implementation readiness, and partnership success 
• Develop ongoing relationships to support future pipeline needs
• Ensure smooth payer partnership contract execution and excellent partner experience 

Qualifications: 

• 10+ years progressive experience within the healthcare field including leading billing and/or payer relations teams in a healthcare setting, or leading a network team within a leading health plan
• Proven track record of establishing, implementing, and growing payer partnerships
• Knowledge of and experience with best practices in medical coding (both CPT and ICD) and compliance
• Solution-oriented, with the ability to offer creative options for problem-solving
• Understanding of health plan network operations, remittance processes, and provider credentialing requirements
• Experience working with external stakeholders such as payers, hospitals, physicians, billing vendors, trade associations, and professional and medical organizations  
• Demonstrated ability to achieve revenue goals and implement programs that improve cash flow
• Strong interpersonal and collaboration skills; ability to work with a diverse team and drive change across the organization
• Strong understanding of reimbursement systems and market access trends
• Comfortable working within Central time hours 

Nice to Have: 

• Bachelor’s Degree in a business-related field or relevant military experience 
• Master’s Degree in health economics, outcomes research, or healthcare-related field preferred 
• Relevant professional certifications including CPB, CPC, CRC, or other equivalent 
• Experience developing processes and implementing systems for remote teams