Payer Integration Manager

🕒 Julho 10

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $80.000 - $92.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Spring Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

💼 Consultoria

🛡️ Seguros

🏥 Saúde

Consulting • Insurance • Healthcare

A Spring Health é uma solução abrangente de saúde mental projetada para empregadores e planos de saúde. Utiliza o Atendimento de Saúde Mental de Precisão para oferecer suporte personalizado ao combinar indivíduos com o atendimento adequado, seja suporte digital, exercícios de meditação, coaching, terapia ou medicação. Ao fazer parcerias com organizações líderes, a Spring Health visa melhorar a acessibilidade e os resultados de saúde mental, reduzir a rotatividade de funcionários e aumentar a produtividade. Confiada por mais de 4. 500 organizações, a empresa fornece uma abordagem baseada em evidências que comprovadamente oferece resultados clínicos e financeiros positivos.

Descrição

• Manage a high volume of concurrent health plan integration workflows, ensuring seamless coordination between internal stakeholders and external carrier technical contacts. • Drive the end-to-end implementation process for payer integrations, overcoming communication or technical barriers to see high-priority data configurations through to completion. • Analyze complex backend data structures, implementation protocols, and integration elements—including 837/835 transaction loops, electronic funds transfers (EFT), and provider configuration profiles—to map the most efficient deployment paths. • Identify integration, billing, and system configuration risks early in the implementation cycle and proactively implement mitigation strategies. • Partner closely with cross-functional technical and non-technical teams to align external payer systems with internal revenue cycle infrastructure. • Maintain a deep, updated understanding of funding structures, benefit designs, compliance requirements, and industry-standard integration practices. • Execute proactive revenue cycle measures during the onboarding phase to ensure clean upstream configuration, healthy billing habits, and strong financial outcomes. • Contribute actively to the continuous improvement of onboarding documentation, deployment checklists, and standard operating procedures to scale our operational efficiency.

🎯 Requisitos

• 3-5 years of relevant professional experience directly managing integrations, implementations, or technical operations with health insurance payers and carriers. • Demonstrated data proficiency, with hands-on experience querying data in Snowflake, building or utilizing reporting in Looker, and interpreting metrics to drive decision-making. • Strong business acumen and analytical skills, with a proven ability to evaluate dashboard numbers, uncover data insights, and translate reports into concrete action plans. • Proven proficiency executing complex, high-volume data integration tasks and projects independently with minimal supervision. • Deep knowledge of core health insurance concepts, payer funding structures, health plan benefit designs, and carrier networks. • Strong technical understanding of healthcare EDI transaction infrastructure and standards, specifically 837 and 835 claim files, billing loops, in-network processing, and provider configuration profiles. • Solid familiarity with general revenue cycle management (RCM) concepts, including claims processing, adjudication, billing regulations, and clearinghouse operations. • Excellent communication and cross-functional collaboration skills, with a track record of effectively translating technical integration elements for non-technical partners. • Experience with HIPAA regulations and associated compliance guidelines regarding electronic healthcare transactions and protected health information (PHI). • Bachelor’s degree in Health Information Management, a related field of coursework, or equivalent practical work experience is preferred.

🏖️ Benefícios

• Health, Dental, Vision benefits start on your first day at Spring. You and your dependents also receive access to One Medical accounts HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type. • Employer sponsored 401(k) match of up to 2% for retirement planning • A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents. • We offer competitive paid time off policies including vacation, sick leave and company holidays. • At 6 months tenure with Spring, we offer parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents. • Access to Noom, a weight management program—based in psychology, that’s tailored to your unique needs and goals. • Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses. • Access to Wellhub, which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription • Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care • Up to $1,000 Professional Development Reimbursement a year. • $200 per year donation matching to support your favorite causes.