About the Role
This role is responsible for managing day-to-day operations with health plan partners, ensuring accurate data exchange, and supporting the scalability of payment reform programs through effective coordination and performance tracking.
Responsibilities
- Lead operational interactions with multiple health insurance partners
- Ensure timely and accurate submission of claims and encounter data
- Monitor performance metrics related to payer data quality and completeness
- Identify and resolve discrepancies in payment and reporting data
- Collaborate with internal teams to align on payer requirements and timelines
- Develop and maintain standard operating procedures for payer-related workflows
- Support onboarding of new health plan partners
- Track and report on key payer performance indicators
- Facilitate regular communication between clinical teams and payer partners
- Improve data integration processes to enhance reporting accuracy
- Manage escalations related to payment disputes or data issues
- Ensure compliance with contractual data obligations
- Optimize reconciliation processes for financial and clinical data
- Coordinate cross-functional initiatives impacting payer operations
- Provide insights to leadership on payer partnership effectiveness
- Drive adoption of best practices in payer relationship management
- Maintain documentation of payer-specific protocols and requirements
- Support audits and regulatory inquiries involving payer data
- Evaluate payer performance against service level agreements
- Contribute to technology enhancements for payer data systems
- Assist in training team members on payer operations standards
- Streamline workflows to reduce manual effort and errors
- Promote consistency in how payer data informs care delivery
- Support strategic goals through reliable payer collaboration
- Ensure operational processes scale with organizational growth
Nice to Have
- Master’s degree in public health, business, or related discipline
- Direct experience in accountable care or care coordination programs
- Familiarity with healthcare data standards such as HL7 or FHIR
- Prior leadership role in a payer or provider organization
- Experience with population health management platforms
- Knowledge of Medicare Advantage or Medicaid managed care
- Exposure to regulatory frameworks like MACRA or MIPS
- Background in healthcare analytics or performance reporting
Compensation
Competitive salary and benefits package
Work Arrangement
Remote
Team
Part of a collaborative healthcare operations team focused on payer partnerships
Why This Role Matters
- This position plays a critical part in ensuring that healthcare payments align with quality outcomes, enabling providers to focus on patient care.
- Effective management of payer relationships directly impacts the success of value-driven care models and long-term sustainability.
Technology Environment
- You’ll work with modern data platforms, secure messaging tools, and cloud-based collaboration software.
- The team uses automation and dashboards to monitor data flows and operational health in real time.
Growth and Development
- Opportunities exist to lead process innovation and mentor junior staff.
- Team members are encouraged to contribute ideas that shape operational strategy and tooling.
Not available
