Manager, Payer Contracting

🕒 Agosto 4

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 35%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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OpenLoop

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2020

💼 Consultoria

⚖️ Jurídico

📦 Logística

💰 $15.000.000 Series A - OpenLoop Health em 2023-03

Consulting • Legal • Logistics

A OpenLoop é uma plataforma de telemedicina marca branca e fornecedora de serviços gerenciados que ajuda as organizações a lançar e escalar programas de atendimento virtual. Combina tecnologia SaaS personalizável (agendamento, reservas, pagamentos, integrações EHR/API) com equipe clínica, credenciamento, cobertura de pagamento e RCM, suporte regulatório/jurídico e suporte ao paciente 24/7. A OpenLoop atende planos de saúde, hospitais e sistemas de saúde, varejistas, empregadores e empresas de saúde digital com operações impulsionadas por IA, uma rede nacional de médicos e ampla cobertura de seguros, incluindo Medicare e Medicaid.

Descrição

• Own OpenLoop’s payer contracting portfolio, including identification, organization, assessment, negotiation, implementation, renewal, and ongoing management • Build an inventory and contracting map across OpenLoop entities, payer relationships, state requirements, renewal dates, fee schedules, and remediation gaps • Determine group-level versus individual provider contracting strategies • Lead negotiations and renegotiations with national and regional health plans • Negotiate reimbursement rates, fee schedules, contract terms, and other financial arrangements • Use utilization, reimbursement, coding, payer mix, and financial data to develop negotiation strategies • Partner with Revenue Cycle Management and coding stakeholders on billing services, codes, and contracting implications • Collaborate with Payer Enrollment to align entities, providers, state identifiers, enrollment requirements, and payer agreements • Coordinate with Revenue Cycle Management, Finance, Clinical Operations, Compliance, and other stakeholders to implement contracts in systems and workflows • Evaluate opportunities to consolidate, restructure, renegotiate, or transition agreements • Support integration of acquired or newly added businesses into OpenLoop’s payer contracting strategy • Maintain knowledge of Medicare, Medicaid, Medicaid Managed Care, Medicare Advantage, and commercial reimbursement requirements • Monitor contract performance, renewals, reimbursement changes, and payer-specific issues • Establish relationships with payer contracting representatives and resolve escalated issues • Serve as subject matter expert and establish scalable contracting processes, documentation, and operating standards • Lead payer contracting projects independently through implementation • Perform other duties as assigned

🎯 Requisitos

• Bachelor’s degree or equivalent relevant experience • 6+ years of progressive experience in payer, managed care, or provider contracting • Significant provider-side payer contract negotiation experience • Experience managing contracts across multiple payers, entities, markets, or states • Strong understanding of group versus individual provider contracting • Deep understanding of healthcare reimbursement methodologies, provider contracting, fee schedules, claims reimbursement, and managed care contracting • Experience evaluating financial and operational data for payer negotiations • Working knowledge of Medicare, Medicaid, Medicaid Managed Care Organizations, Medicare Advantage, and commercial payer contracting • Experience partnering with Revenue Cycle Management, Payer Enrollment, Finance, Coding, Clinical Operations, and other stakeholders • Ability to structure incomplete or fragmented information, identify gaps, develop solutions, and drive completion • Ability to manage multiple complex priorities and sensitive deadlines autonomously • Preferred: experience in both payer and provider organizations • Preferred: national healthcare, telehealth, physician group, hospital, or multi-state provider organization experience • Preferred: value-based contracting or alternative reimbursement arrangements • Preferred: consolidating or restructuring payer agreements after acquisitions or organizational changes • Preferred: familiarity with MDStaff, Medallion, or Verisys • Preferred: familiarity with payer portals, healthcare billing systems, contract management tools, Jira, Zendesk, or Zoho Desk

🏖️ Benefícios

• Medical, Dental & Vision • Flexible Spending / Health Savings Accounts • Generous PTO and company holidays • 401(k) • Competitive compensation • Additional benefits and programs based on eligibility • Remote work arrangement