Director - Payer analytics and Negotiation

About Sciometrix

At Sciometrix, our goal is to deliver the best‑ever personalized care with utmost compassion enabling patients to lead healthier and happier lives. Our commitment to innovation in healthcare technology drives us to lead the way in Care Management, Digital Care Coordination, Value‑Based Care, and Population Health. We envision a world where advanced technology and human compassion intersect seamlessly to deliver superior patient experiences and outcomes.

Our mission is to enhance the lives of patients by leveraging digital solutions that reduce hospital readmissions, improve health outcomes, and optimize the delivery of healthcare services.

At the heart of our philosophy lies the belief that every patient deserves access to the highest quality of care, tailored to their individual needs. We strive to make this vision a reality by pioneering innovative solutions that prioritize patient well‑being and provider efficiency. With Sciometrix, the future of healthcare is not just about treating illnesses; it's about empowering patients to live their best lives.

What’s in it for you?

Innovative & Strategic Healthcare Leadership

Join a forward‑thinking digital health company where your expertise in payer contracting and revenue optimization drives sustainable virtual care delivery. We foster an inclusive, dynamic environment where strategic thinking, business acumen, and leadership excellence directly impact financial performance and organizational growth.

Collaborative, Cross‑Functional Leadership

Lead and collaborate with revenue cycle, billing, claims, and clinical teams to negotiate payer contracts, develop reimbursement strategies, and optimize revenue performance. Your guidance will be critical in ensuring compliance, reducing denials, and driving efficiency across the revenue cycle.

Cutting‑Edge Telehealth & Revenue Tools

Leverage proprietary, HIPAA‑compliant software and AI‑driven tools like Clinicus to monitor performance metrics, enhance contract management, and drive data‑driven revenue strategies. Use technology to inform decisions and maximize reimbursement opportunities.

Impactful Role in Revenue Growth & Contracting

Make a significant impact by developing payer strategies, identifying revenue opportunities, managing risk, and ensuring contractual compliance. Your strategic initiatives will directly contribute to financial stability, operational efficiency, and measurable revenue growth.

Global Network & Professional Growth

Expand your professional network while collaborating with healthcare, technology, and payer professionals worldwide. Be part of an organization that values innovation, encourages executive leadership growth, and supports strategic influence across the revenue cycle.

Commitment to Diversity, Inclusion & Belonging

We are committed to building a safe, inclusive workplace where every team member feels respected and empowered. Our leadership prioritizes creating an environment where you can bring your authentic self to work and inspire others.

Competitive Compensation & Benefits

Enjoy a competitive salary aligned with your experience, along with benefits designed to support your well‑being and work‑life balance, including remote work opportunities, health insurance coverage, accidental wellness cover, company‑provided devices, internet reimbursement, paid leaves, and optional holidays.

Positive & Rewarding Work Environment

Join a company recognized for clinical excellence, patient satisfaction, and provider success — where your contributions to strategic payer contracting, revenue optimization, and organizational growth are valued, supported, and celebrated.

Role Overview

We are seeking a strategic and results‑driven Director - Payer Analytics and Negotiation to lead payer strategy, reimbursement optimization, and revenue integrity for our Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs.

This role will play a critical leadership function in scaling CCM and RPM services across Medicare, Medicaid, and Commercial payers by ensuring compliant billing, accurate reimbursement, strong payer alignment, and optimized financial performance.

Location: India (Remote)

Key Responsibilities

- Lead payer contract strategy for CCM and RPM services, including CPT codes.

- Interpret and operationalize payer contracts, coverage policies, and fee schedules for CCM/RPM programs.

- Ensure reimbursement accuracy and compliance with CMS billing, documentation, consent, and time requirements.

- Oversee identification, recovery, and appeal of CCM/RPM underpayments and reimbursement variances.

- Reduce CCM/RPM denials related to coverage, consent, documentation, and medical necessity.

- Partner with clinical, care management, operations, finance, and compliance teams to align workflows with payer requirements.

- Ensure accurate contract loading and validation of CCM/RPM rates in EMR and Practice Management systems.

- Support payer negotiations and coverage expansion using financial and utilization analysis.

- Lead and develop payer contracting, financial analysis, and denial management teams.

- Establish SOPs, reporting, and governance to scale and optimize CCM/RPM revenue performance.

Key Performance Indicators (KPIs)

- ≥ 98% CCM/RPM contract load accuracy

- Reduced CCM/RPM underpayments, write‑offs, and denial rates

- Improved CCM/RPM net collection rates and revenue per enrolled patient

- Faster payer contract onboarding and implementation

Qualifications

- Bachelor’s degree in Healthcare Administration, Finance, Business, or related field; MBA/MHA preferred

- 8-12+ years of Revenue Cycle Management experience

- 5+ years managing CCM and/or RPM or similar value‑based care programs

- Strong expertise in Medicare and Commercial CCM/RPM reimbursement

- Advanced knowledge of CMS CCM/RPM billing and compliance requirements

Core Competencies

- CCM/RPM CPT codes, billing rules, and payer policies

- EMR systems supporting CCM/RPM workflows (Epic, Athena, eCW, NextGen, or similar)

- Contract analysis, reimbursement modeling, and variance resolution

- Strategic leadership with a strong compliance and revenue focus

- Executive communication and payer negotiation skills

Sciometrix is an Equal Opportunity Employer and is proud to offer equal employment opportunities to all individuals regardless of race, color, ancestry, religion, gender, national origin, sexual orientation, age, citizenship, disability, gender identity, veteran status, or any other protected characteristic.

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