Director Single Billing Office, Payor Management

Inova Health is seeking an experienced people leader for the Director of Single Billing Office, Payor Management role.

The Director of SBO Payor Management provides strategic direction and operational leadership for all Single Business Office (SBO) functions related to claims processing, follow-up, denial prevention and resolution, and payor management across hospital and physician billing. This role is accountable for driving accurate and timely cash flow across all payor types in both acute and ambulatory care settings.

• Serves as a thought partner to Revenue Cycle, Finance, and Managed Care leadership in aligning departmental strategies and operational execution with enterprise financial goals.
• Develops change management and long-term strategic plans to evolve SBO and payor management functions, ensuring agility in response to changing reimbursement models, policy and regulatory shifts. Develops and executes initiatives to optimize claims processing, follow-up, denial prevention, and management.
• Leads strategic initiatives to enhance quality, efficiency, and financial outcomes by streamlining workflows, eliminating inefficiencies, and driving continuous process improvement. Champions a culture of innovation through the adoption of emerging technologies, digital tools, and automation to reduce barriers and inefficiencies and to optimize performance. Designs scalable and resilient solutions that anticipate future-state needs and support enterprise growth and transformation.
• Leads strategic use of analytics in collaboration with data teams to forecast performance, model reimbursement scenarios, accelerate cash, and prevent revenue leakage. Develops data-driven strategies and executive insights that influence payor relations, contract optimization, and financial planning. Leverages Epic and other revenue cycle technologies to identify inefficiencies, implement best practices, and direct enhancements to system components. Implements automation and digital transformation strategies to enhance operational efficiency, reduce rework, and improve financial outcomes. Utilizes business intelligence tools such as Tableau, Power BI, and Epic Reporting tools to monitor KPIs and generate actionable insights.
• Oversees the end-to-end claims lifecycle, ensuring accurate billing, timely follow-up, and efficient denial resolution. Drives proactive strategies to reduce avoidable write-offs through effective controls, accurate adjustment practices, and collaboration with payors and internal stakeholders. Ensures adjustments are properly categorized, compliant with contract terms and regulatory requirements, and aligned with organizational policies.
• Conducts regular root cause analysis of denials, rejections, and rework, implementing systemic solutions rather than claim-level fixes. Champions clean claim initiatives by improving front-end edits, eligibility validation, charge integrity, and documentation workflows. Monitors KPIs across the end-to-end revenue cycle to identify trends, drive accountability, and implement targeted improvements that optimize financial and operational outcomes. Understands and optimizes workqueue logic to define, prioritize, and distribute work effectively, leveraging system capabilities to drive staff productivity, streamline workflows, and ensure timely resolution of account activities.
• Acts as a liaison between SBO operations and departments including Managed Care, Compliance, Patient Access, IT, and Clinical Operations to resolve payor issues, improve workflows, and ensure alignment across front-end, mid-cycle, and back-end processes.
• Engages with executive stakeholders through clear, data-driven communication of trends, translating complex metrics into actionable insights that inform strategic decisions and support enterprise goals and initiatives.
• Communicates new payor requirements and revenue cycle initiatives to relevant teams.
• Ensures compliance with federal, state, and payor-specific billing regulations. Identifies and mitigates risks related to revenue cycle operations.
• Collaborates with payors and Managed Care to resolve systemic issues, enhance payment integrity, and ensure adherence to contract terms. Escalates issues and trends in monthly payor meetings to proactively address denials, underpayments, and administrative delays.
• Leverages internal escalation pathways to resolve persistent, revenue-impacting issues, engaging executive leadership or contract administrators when needed. Tracks and analyzes payor behavior to identify opportunities for operational alignment, policy clarification, or contract renegotiation.

Minimum Qualifications:

• Experience - Eight years of Back-end revenue cycle management experience; Three years of management experience
• Education - Bachelor's degree in Finance, Business Administration, Healthcare Management, or a related field, or equivalent experience in lieu of degree

Preferred Qualifications:

• Demonstrated experience leading the implementation and scaling of automation, artificial intelligence (AI), and advanced digital solutions within revenue cycle or healthcare financial operations.