Apply on Employer Site

Boulder Care · 7 hours ago

Director of Revenue and Payer Operations

United States

Full-time

Remote

Lead/Staff, Director/Executive

$145K/yr - $160K/yr

5+ years exp

Bouldercare is seeking a strategic and analytical Director of Revenue and Payer Operations to lead their growth efforts. The role involves managing payer contracting, optimizing contract performance, and providing strategic guidance to ensure revenue growth and market entry success.

Health CareMedicalTelehealthTherapeutics

No H1B

Responsibilities

Manage operational tracking for the payer contracting function, including reimbursement terms, pipeline reporting, and forecasting

Conduct fee schedule analyses, assess financial impact, and advise on coding/reimbursement alignment to support performance under value-based contracts

Build and maintain financial models to inform rate negotiations and track contract performance

Partner with Finance and Operations to ensure smooth contract implementation

Support large or complex contract opportunities, ensuring cross-functional alignment

Research and analyze Medicaid policy, market dynamics, and competitor positioning to inform market entry strategy

Develop strategic frameworks for growth, including FFS optimization and value-based contracting readiness

Advise leadership on opportunities and risks tied to payer strategy

Provide modeling, research, and contracting insights to support business development initiatives

Monitor contract performance against metrics and targets

Track payments, quality measures, and incentive programs, identifying gaps and opportunities

Partner with Finance and Ops to ensure reporting accuracy and compliance

Develop dashboards and reporting to guide business decisions and optimize payer strategy

Deliver regular KPI reporting to leadership, highlighting risks and opportunities

Act as the central business partner for internal teams (Data, Product, Finance, Clinical) on payer strategy and operations

Create and maintain source-of-truth documents and dashboards

Take on high-priority special projects to advance payer-facing growth

Qualification

Healthcare contractingFee schedule analysisValue-based care modelsFinancial modelingProject managementAnalytical skillsCommunication skillsStrategic thinking