Village Practice Management Company is seeking a Director, Payer Operations to serve as a strategic and operational leader accountable for driving enterprise-level initiatives. You will ensure the effective execution, optimization, and compliance of the full payer operations lifecycle within our physician-led, patient-centric network committed to simplifying health care.
What You'll Do
- Lead the development and execution of a multi-year strategy for end-to-end payer operations, credentialing, and provider enrollment.
- Oversee complex initiatives including practice participation lifecycle and value-based contracting.
- Build and lead high-performing, cross-functional teams focused on contract lifecycle management, roster accuracy, and operational compliance.
- Manage the full lifecycle of provider contracts from intake, eligibility verification, roster submission, and reconciliation to withdrawal.
- Establish standard operating procedures and scalable frameworks to manage practice participation in value-based contracts.
- Collaborate with Legal, Strategic Payer Partnerships, and Product teams to ensure contract integrity and adherence to standards.
- Serve as business owner for external platforms and internal data systems related to contract and roster management.
- Identify and lead operational process improvement opportunities to reduce errors, rework, and cycle time.
- Redesign existing workflows for scalability, efficiency, and regulatory compliance.
- Implement Lean, Six Sigma, or similar frameworks to ensure measurable, sustainable process enhancements.
- Establish and oversee QA processes to ensure data integrity across systems, tools, and reporting.
- Define business rules for translating contract and roster data between systems.
- Develop and execute proactive audit strategies, error-intake processes, and root cause analyses.
- Partner with compliance, finance, and technology teams to ensure audit readiness and mitigate risk.
- Work closely with IT, Product, Legal, Compliance, Clinical, and Finance teams to develop and implement integrated solutions.
- Represent the business in the design and implementation of new tools, platforms, and UIs that support operational excellence.
- Lead business input on systems integrations and improvements, focusing on usability, data accuracy, and operational impact.
- Define and monitor KPIs for payer operations.
- Create and present executive-level dashboards and insights, highlighting trends, risks, and improvement opportunities.
- Ensure feedback loops are in place to adjust strategy and tactics based on performance data.
What We're Looking For
- Bachelor’s degree in Healthcare Administration, Business, or related field.
- PMP Certification.
- 10+ years of experience in healthcare operations, with direct experience in payer contracting, provider credentialing, or claims operations.
- 6+ years of leadership experience managing cross-functional teams and enterprise-level initiatives.
- Demonstrated success in building and scaling complex organizational change management and operational processes across multiple stakeholders.
- Strong analytical and critical thinking skills; ability to quickly interpret data, identify root causes, and drive action.
- Experience working with tools like Salesforce, Power BI, Google Suite, and internal claims or contract management platforms.
- Excellent verbal, written, and presentation skills; ability to communicate clearly with senior leaders and technical stakeholders.
Nice to Have
- Master’s degree in Healthcare Administration, Business, or related field.
- Experience with value-based care and alternative payment models.
- Familiarity with compliance frameworks (e.g., CMS, HIPAA, Medicaid guidelines).
- Certification in Lean, Six Sigma, or process improvement methodologies.
Technical Stack
- Salesforce
- Power BI
- Google Suite
- Internal claims or contract management platforms
Benefits & Compensation
- Medical
- Dental
- Life
- Disability
- Vision
- FSA coverages
- 401k savings plan
Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.
