Senior Director, Contract Compliance & Performance

The Senior Director, Contract Compliance & Performance is a senior operational and analytical leader responsible for executing the enterprise Contract Compliance & Performance strategy under the direction of the Associate Vice President, Contract Compliance & Performance.

The Senior Director leads the day-to-day monitoring, analysis, validation, and remediation of payer contract performance across the health system, including hospital, ambulatory, physician, and faculty practice operations.

The position translates payer contract requirements into measurable operational controls, reimbursement analytics, monitoring processes, and actionable performance intelligence. The Senior Director is responsible for identifying discrepancies between contracted and actual reimbursement, quantifying financial impact, coordinating root-cause analysis, and driving resolution of contract-performance issues.

Working in close partnership with Managed Care Contracting, Revenue Cycle, Finance, Patient Financial Services, Physician Enterprise, Faculty Practice, Information Technology, Data & Analytics, Compliance, Legal, and operational leadership, the Senior Director ensures that contract-performance issues are identified early, appropriately escalated, and resolved through sustainable corrective and preventive actions.

The Senior Director serves as a key deputy to the AVP and provides leadership for the operational execution and maturation of the Contract Compliance & Performance function.

Essential Responsibilities

1. Contract Compliance & Performance Operations

Execute the enterprise Contract Compliance & Performance framework established by the AVP.

Responsibilities include:

• Lead day-to-day operations of the Contract Compliance & Performance function.
• Implement standardized processes for monitoring payer contract compliance and performance.
• Monitor contractual reimbursement, payment accuracy, contractual obligations, and payer performance.
• Identify, quantify, and prioritize material reimbursement variances.
• Establish work plans for investigating and resolving identified contract-performance issues.
• Maintain appropriate tracking of identified issues, financial exposure, corrective actions, owners, and resolution status.
• Escalate significant contractual, financial, operational, or compliance risks to the AVP.
• Provide regular performance updates, trend analysis, and recommendations to the AVP.
• Support development and implementation of enterprise contract-performance standards.
• Identify opportunities to improve monitoring processes, controls, analytics, and operational workflows.
• Ensure consistent application of Contract Compliance & Performance methodologies across hospital and professional environments.

2. Contract Operationalization & Implementation

Support the AVP in ensuring negotiated payer agreements and amendments are accurately translated into operational and system requirements.

Responsibilities include:

• Review payer contracts, amendments, rate changes, and reimbursement provisions for operational implications.
• Translate contractual requirements into documented business, operational, and analytical requirements.
• Partner with Managed Care, Revenue Cycle, IT, Finance, and operational teams on contract implementation.
• Participate in contract configuration, testing, validation, and implementation activities.
• Validate that reimbursement methodologies, fee schedules, rates, escalators, and payment provisions are appropriately reflected in applicable systems.
• Establish and maintain implementation checklists and validation protocols.
• Conduct post-implementation testing to identify discrepancies between contractual requirements and operational/system outcomes.
• Track implementation issues through resolution.
• Maintain documentation of contract interpretations, assumptions, requirements, testing results, and implementation decisions.
• Ensure amendments and rate changes are incorporated into monitoring and validation processes in a timely manner.
• Escalate implementation risks or delays that may result in financial loss or contractual noncompliance.

3. Reimbursement Analytics & Payment Validation

Lead operational execution of methodologies designed to determine whether payer reimbursement aligns with contractual expectations.

Responsibilities include:

• Oversee development and execution of expected reimbursement methodologies.
• Analyze actual versus expected reimbursement across applicable payer arrangements.
• Identify underpayments, overpayments, payment variances, and other deviations from contractual expectations.
• Quantify financial impact associated with identified reimbursement discrepancies.
• Establish and maintain prioritization methodologies based on financial value, frequency, risk, payer significance, and operational impact.
• Conduct detailed analysis of payment variance trends.
• Identify patterns associated with payer behavior, billing processes, system configuration, coding, contractual interpretation, or other root causes.
• Distinguish isolated payment discrepancies from systemic issues.
• Develop recurring monitoring processes for high-risk reimbursement provisions.
• Partner with Revenue Cycle and operational teams to validate findings and implement corrective action.
• Monitor remediation results to determine whether identified issues have been sustainably resolved.
• Provide analytical support for recovery and dispute activities.

4. Contract Performance Monitoring

Develop and maintain ongoing monitoring of payer contract performance.

Responsibilities include:

• Establish recurring monitoring schedules for high-value and high-risk contractual provisions.
• Monitor payer reimbursement performance against contractual expectations.
• Develop payer-specific and contract-specific performance profiles.
• Identify emerging payment trends and areas of financial opportunity or risk.
• Monitor the financial impact of reimbursement methodologies, contractual provisions, rate changes, and payment policies.
• Develop exception-based monitoring to focus resources on material issues.
• Establish thresholds for investigation and escalation in partnership with the AVP.
• Track unresolved issues and aging of remediation activities.
• Provide periodic reporting on contract-performance trends.
• Recommend enhancements to monitoring methodologies based on emerging risks and organizational priorities.

5. Analytics, Reporting & Revenue Intelligence

Lead development and maintenance of operational reporting supporting Contract Compliance & Performance.

Reporting may include:

• Contracted versus actual reimbursement
• Payment accuracy
• Payment variance
• Underpayment opportunities
• Recovery performance
• Payer performance
• Contract implementation status
• Contractual rate and methodology changes
• Denial and appeal trends
• Material contract-performance risks
• Open remediation activities
• Financial impact of identified issues

Responsibilities include:

• Establish and maintain standardized reporting methodologies.
• Partner with Revenue Reporting and Intelligence and Data & Analytics to ensure accurate and reliable data.
• Develop dashboards, reports, payer scorecards, and management tools.
• Translate analytical findings into actionable recommendations.
• Validate data used in contract-performance reporting.
• Establish quality-control processes for critical reports and analytics.
• Identify opportunities for automation and exception-based reporting.
• Support development of predictive and advanced analytics.
• Evaluate opportunities to use artificial intelligence and automation to improve payment validation, variance detection, and prioritization.
• Ensure reporting aligns with enterprise definitions and methodologies established by the AVP.

6. Root-Cause Analysis & Corrective Action

Lead structured investigation of material and recurring contract-performance issues.

Responsibilities include:

• Conduct root-cause analysis of reimbursement discrepancies.
• Determine whether issues originate from contractual interpretation, payer behavior, billing, coding, system configuration, data, workflow, or other operational factors.
• Coordinate cross-functional investigation of systemic issues.
• Develop corrective and preventive action plans.
• Establish clear ownership, milestones, and expected outcomes for remediation activities.
• Monitor corrective actions through completion.
• Validate that corrective actions have produced the intended financial and operational results.
• Identify recurring issues requiring enterprise-level intervention.
• Escalate unresolved or systemic issues to the AVP.
• Recommend changes to processes, controls, system configuration, or contractual monitoring based on findings.

7. Appeals, Disputes & Recovery Support

Provide operational leadership and analytical support for significant payer payment disputes and recovery opportunities.

Responsibilities include:

• Identify and prioritize payment recovery opportunities.
• Support development of documentation and analytical evidence for contractual disputes.
• Analyze disputed claims and reimbursement methodologies.
• Coordinate with Revenue Cycle and Managed Care on recovery activities.
• Monitor recovery performance and outstanding payer issues.
• Track disputes by financial value, payer, issue type, age, and resolution status.
• Identify recurring disputes that may indicate systemic contract-performance problems.
• Escalate significant disputes to the AVP and appropriate Managed Care or Legal leadership.
• Support formal dispute resolution, arbitration, or other escalation activities when requested.
• Evaluate the effectiveness of recovery strategies and recommend process improvements.

8. Managed Care & Payer Partnership

Support the AVP and Managed Care leadership with contract-performance intelligence.

Responsibilities include:

• Provide payer-performance analysis to support contract negotiations and renewals.
• Prepare historical reimbursement and performance analyses.
• Analyze proposed reimbursement methodologies and contractual changes.
• Identify provisions that may create operational or financial risk.
• Develop financial impact analyses and scenario models.
• Provide data supporting payer performance discussions.
• Monitor performance against negotiated expectations.
• Identify payer trends that may require strategic attention.
• Support escalation of significant payer-performance concerns.
• Translate operational findings into actionable information for Managed Care leadership.

9. Audit, Compliance & Risk Monitoring

Support the AVP in maintaining a risk-based contract compliance monitoring program.

Responsibilities include:

• Conduct periodic reviews of high-risk or high-value contractual provisions.
• Execute monitoring activities in accordance with established compliance methodologies.
• Maintain documentation supporting monitoring activities, findings, and remediation.
• Coordinate with Corporate Compliance, Internal Audit, Legal, Finance, and other oversight functions as appropriate.
• Support internal and external audits involving payer reimbursement.
• Identify potential contractual, financial, operational, or compliance risks.
• Escalate material findings in accordance with established governance protocols.
• Track corrective actions associated with audit or monitoring findings.
• Support assessment of applicable Medicare, Medicaid, commercial payer, and state reimbursement requirements.
• Maintain appropriate evidence supporting contract-performance conclusions.

The Senior Director will work in partnership with, but will not replace, the independent authority of Corporate Compliance, Legal, Internal Audit, or other designated oversight functions.

10. Technology, Systems & Data Management

Partner with IT, Revenue Cycle technology teams, Data & Analytics, and Revenue Reporting and Intelligence to support contract-performance capabilities.

Responsibilities include:

• Define and document business requirements for contract-performance analytics and monitoring.
• Participate in system enhancement and technology roadmap initiatives.
• Support development and validation of contract modeling and reimbursement tools.
• Participate in testing of contract configuration and payment logic.
• Validate system changes associated with payer contracts and amendments.
• Identify data-quality issues affecting contract-performance analytics.
• Establish appropriate quality controls for critical contract-performance data.
• Support automation of payment validation and variance detection.
• Evaluate technology solutions that improve contract monitoring and reimbursement intelligence.
• Participate in implementation and optimization of tools supporting contract compliance.

11. Enterprise Governance & Process Management

Support the AVP in maintaining effective enterprise governance for Contract Compliance & Performance.

Responsibilities include:

• Implement policies, procedures, standards, and controls established for the function.
• Maintain clear documentation of roles, responsibilities, decision rights, and escalation pathways.
• Coordinate governance activities involving Contract Compliance & Performance and related functions.
• Prepare materials for governance committees and executive reviews.
• Track decisions, action items, risks, and remediation activities.
• Identify gaps or duplication among Contract Compliance & Performance, Managed Care, Revenue Cycle, Finance, Compliance, and Legal.
• Recommend process improvements to strengthen accountability.
• Promote consistent enterprise methodologies while recognizing differences among hospital, ambulatory, physician, and faculty practice environments.

12. Leadership & Organizational Management

Provide senior leadership for the operational teams supporting Contract Compliance & Performance.

Responsibilities include:

• Lead and develop a high-performing multidisciplinary team.
• Establish team goals, priorities, performance expectations, and operating rhythms.
• Translate the AVP's strategic priorities into actionable departmental plans.
• Manage day-to-day workload, resources, and competing priorities.
• Develop workforce and resource requirements.
• Participate in recruitment, onboarding, development, and retention of talent.
• Establish performance-management practices.
• Develop succession and career-development opportunities.
• Foster accountability, collaboration, innovation, and continuous improvement.
• Promote effective communication across geographically and operationally diverse teams.
• Establish appropriate quality and productivity standards.
• Identify opportunities to improve team structure, processes, and capabilities.
• Serve as a senior representative of the Contract Compliance & Performance function.

Organizational Leadership

The Senior Director may oversee multidisciplinary teams and functions including:

• Contract Compliance Analysts
• Senior Contract Compliance Analysts
• Contract Performance Analysts
• Reimbursement Analysts
• Payment Validation
• Contract Modeling
• Payer Performance Reporting
• Contract Audit and Monitoring
• Data and Reporting
• Contract Performance Project Management

The Senior Director will establish an operating environment that promotes analytical rigor, operational accountability, timely issue resolution, and effective partnership with enterprise stakeholders.

Cross-Functional Collaboration

Develop and maintain effective working relationships across:

• Contract Compliance & Performance
• Revenue Reporting and Intelligence
• Revenue Cycle
• Managed Care Contracting
• Finance
• Patient Financial Services
• Corporate Compliance
• Legal
• Physician Enterprise
• Faculty Practice
• Clinical Operations
• Health Information Management
• Coding
• Information Technology
• Data & Analytics
• Internal Audit
• Enterprise Risk Management

The Senior Director is expected to operate effectively across a highly matrixed organization and drive resolution of issues that require collaboration across multiple functions.

• Graduate degree in Business or Healthcare Administration. 

• 7-10 years of experience in health administration including a minimum of 3 years preferred leadership in a health care setting. 

Department requirements(pending comp approval) 

• Bachelor's degree in healthcare administration, finance, business administration, accounting, health information management, data analytics, or a related field.

• Master's degree preferred, including MBA, MHA, MPH, or related advanced degree

•  7 years of progressive experience in healthcare finance, payer contracting, reimbursement, revenue cycle, contract compliance, revenue analytics, or a related field. Strong preference  for candidates with  10 or more years of experience
• Significant experience in payer contract performance, reimbursement analytics, payment validation, or revenue-cycle analytics.
• Experience working within a large academic medical center, integrated delivery network, multi-hospital health system, or similarly complex healthcare organization.
• Experience with both facility and professional reimbursement strongly preferred.
• Demonstrated experience leading complex analytical, operational, or enterprise initiatives.
• Experience partnering with Managed Care, Revenue Cycle, Finance, IT, Compliance, and operational leadership.
• Demonstrated ability to translate contractual and reimbursement requirements into operational processes, analytics, controls, and measurable outcomes.
• Experience leading teams of analysts, managers, or other professional staff.

Preferred Qualifications

• Experience within a major academic medical center or integrated academic health system.
• Experience with commercial, Medicare, Medicaid, and value-based reimbursement arrangements.
• Experience supporting payer negotiations and contract strategy.
• Experience with Epic hospital and professional billing environments.
• Experience with contract modeling, payment validation, or reimbursement analytics technologies.
• Experience developing payer scorecards and executive dashboards.
• Experience with healthcare data warehouses and enterprise analytics platforms.
• Experience using automation, machine learning, or artificial intelligence in healthcare financial analytics.
• Experience with large-scale revenue-cycle transformation.
• Experience establishing enterprise governance and standardized processes.
• HFMA, healthcare finance, revenue-cycle, analytics, or project-management certification.

Knowledge, Skills & Abilities

• Advanced knowledge of healthcare payer reimbursement and contract performance.
• Strong understanding of hospital and professional reimbursement methodologies.
• Knowledge of Medicare, Medicaid, and commercial payer requirements.
• Understanding of DRG, APC, CPT, HCPCS, fee schedule, percentage-of-Medicare, case rates, and other reimbursement methodologies.
• Strong financial and quantitative analysis skills.
• Ability to interpret complex payer contract provisions.
• Ability to translate contractual requirements into operational and analytical requirements.
• Strong understanding of revenue-cycle operations.
• Experience with payment variance and reimbursement analysis.
• Strong data-management and reporting capabilities.
• Ability to develop meaningful dashboards and performance indicators.
• Strong project and process-management skills.
• Excellent written, verbal, and presentation skills.
• Ability to communicate complex analytical findings to executive and operational audiences.
• Demonstrated ability to influence without direct authority.
• Strong problem-solving and root-cause-analysis capabilities.
• Strong organizational and prioritization skills.
• Ability to manage multiple enterprise initiatives simultaneously.
• Strong change-management and process-improvement capabilities.
• Ability to lead and develop high-performing teams.

Key Performance Indicators

Performance should be evaluated using financial, operational, analytical, compliance, and organizational measures.

Financial & Contract Performance

• Contracted versus actual reimbursement accuracy
• Identification of material payment variances
• Financial value of identified opportunities
• Recovery and remediation performance
• Reduction in recurring reimbursement leakage
• Timeliness of financial opportunity identification
• Accuracy of expected reimbursement methodologies

Operational Performance

• Contract implementation timeliness
• Contract implementation accuracy
• Variance investigation turnaround time
• Issue resolution cycle time
• Corrective-action completion
• Sustainability of remediation
• Adoption of standardized monitoring processes

Analytics & Reporting

• Accuracy of contract-performance reporting
• Timeliness of reporting
• Dashboard utilization
• Data-quality performance
• Effectiveness of exception-based monitoring
• Development of new analytical capabilities
• Automation and process-efficiency improvements

Compliance & Risk

• Completion of scheduled monitoring
• Timeliness of risk identification and escalation
• Audit findings and remediation
• Documentation quality
• Resolution of material contract-performance issues
• Compliance with established monitoring standards

Strategic & Organizational Performance

• Quality of support provided to Managed Care and executive leadership
• Cross-functional stakeholder effectiveness
• Advancement of Contract Compliance & Performance maturity
• Team engagement and retention
• Talent development
• Succession readiness
• Achievement of departmental strategic objectives

Certifications

Relevant professional certifications may be preferred, including:

• HFMA Certified Healthcare Financial Professional (CHFP)
• HFMA Certified Revenue Cycle Representative (CRCR)
• Project Management Professional (PMP)
• Other relevant healthcare finance, reimbursement, compliance, analytics, or revenue-cycle certifications

Leadership Competencies

The successful candidate will demonstrate:

• Operational Leadership: Ability to translate enterprise strategy into disciplined execution, measurable outcomes, and sustainable processes.
• Analytical Leadership: Ability to interpret complex reimbursement and contractual data and translate findings into actionable decisions.
• Enterprise Perspective: Ability to understand interdependencies across Revenue Cycle, Managed Care, Finance, IT, Compliance, and clinical and physician operations.
• Executive Communication: Ability to communicate complex issues concisely and effectively to senior leaders.
• Influence & Collaboration: Ability to drive results across a matrixed organization without relying solely on direct authority.
• Accountability: Demonstrated ownership of issues, transparency regarding risks, and commitment to measurable results.
• Problem Solving: Ability to identify root causes and develop practical, sustainable solutions.
• Continuous Improvement: Ability to identify opportunities to improve processes, controls, technology, and analytical capabilities.
• Change Leadership: Ability to implement new processes and operating models in complex environments.
• Talent Development: Ability to recruit, coach, develop, and retain high-performing analytical and operational talent.

Role Scope

The Senior Director, Contract Compliance & Performance is a senior operational leader responsible for executing and advancing the enterprise Contract Compliance & Performance strategy under the direction of the Associate Vice President.

The position serves as a critical link between contractual requirements, reimbursement analytics, payment validation, operational controls, issue remediation, and executive intelligence.

The Senior Director does not replace the responsibilities or independent authority of Managed Care Contracting, Revenue Cycle Operations, Corporate Compliance, Legal, Finance, Internal Audit, or Clinical leadership. Rather, the role provides the operational leadership necessary to identify contract-performance issues, quantify their impact, coordinate cross-functional resolution, and ensure that corrective actions are implemented and sustained.

The Senior Director is expected to function as a strategic deputy and operational extension of the AVP, assuming responsibility for day-to-day execution of the Contract Compliance & Performance operating model while escalating material risks, strategic decisions, and enterprise-level issues to the AVP.

The role is accountable for ensuring that the organization's payer agreements are translated into measurable performance expectations and that material gaps between contracted economics and actual reimbursement are identified, investigated, remediated, and prevented from recurring.