Manager, Payer Contracting

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OpenLoop

WebsiteLinkedInAlle Stellen

201 - 500 Mitarbeiter

Gegründet 2020

☁️ SaaS

🤝 B2B

🏢 Unternehmen

💰 €15.000.000 Series A - OpenLoop Health im 2023-03

SaaS • B2B • Enterprise

OpenLoop ist eine White-Label-Telemedizin-Plattform und ein Anbieter von Managed Services, die Organisationen dabei hilft, virtuelle Versorgungsprogramme zu starten und zu skalieren. Sie kombiniert SaaS-basierte, markenfähige Technologie (Terminplanung, Buchung, Zahlungen, EHR/API-Integrationen) mit klinischem Personal, Akkreditierung, Kostenträgerabdeckung und RCM, regulatorisch/rechtliche Unterstützung und 24/7 Patientenunterstützung. OpenLoop bedient Gesundheitspläne, Krankenhäuser und Gesundheitssysteme, Einzelhändler, Arbeitgeber und digitale Gesundheitsunternehmen mit KI-gestützten Operationen, einem landesweiten Netz von Klinikern und einer breiten Versicherung, einschließlich Medicare und Medicaid.

Beschreibung

• Acquisition, coordination, and analysis of payer contracts • Secure and maintain group-level contracts with payers including delegated payer contracts where able - leaning on OpenLoop’s NCQA Accreditation. • Negotiation of fee schedules for new and existing contracts efficiently and effectively that are favorable for the organization • Collaboration with the Payer Enrollment and RCM teams to ensure contracts are appropriately identified, negotiated, implemented, and reviewed in a timely manner • Collaboration with other functional areas of the organization to ensure payer contracts are structured in a manner that yields a positive impact on the company • Review of contract terms and conditions in order to facilitate accurate implementation of contracts • Maintain current knowledge of Medicare reimbursement methodologies, State Medicaid (including MCO’s) payment methodologies, and Commercial (including commercial MA plans) payment methodologies • Coordinate fee schedule development with our RevOps team utilizing financial models and analysis in negotiating rates with Payers • Manage and oversee all group-level payer contracts • May serve as a liaison internally between Billing/Coding, Finance, Information Technology, and Clinical Operations as it relates to group payer contract updates and changes • Monitor renewals for contacts and renegotiate contracts as appropriate upon renewal • Establish productive professional relationships with Payer Contract representatives • Resolve escalated contract specific issues of Payers • Assist with analysis of payer mix and rate structure of Payer contracts • Maintain working knowledge of billing database for reporting purposes • Manage special projects and other duties as required

🎯 Anforderungen

• Bachelor’s Degree • 4+ years prior experience in managed care contracting in a provider or payer setting • Extensive understanding of payer contract reimbursement and analytic modeling • Value based contracting experience • Experience managing multiple tasks simultaneously while assisting team members in routine daily activities • Working knowledge of current policies and guidelines that affect contracts, pricing, rebates, legislative regulations, etc. in the managed care environment • Knowledge of provider contracting, financial arrangements, and fee schedules, including understanding of healthcare reimbursement methodologies and guidelines preferred • Knowledge of claims processing systems and guidelines • Proficiency with computer data entry, GSuite, payer portal navigation, provider data management systems such as MDStaff, Medallion, or Verisys, experience with ticking platforms such as Jira, ZenDesk, or Zoho Desk. • Ability to adapt and navigate business related software • Ability to meet sensitive deadlines, organize workload with limited supervision

🏖️ Vorteile

• Medical, Dental, and Vision plans • Flexible Spending/Health Savings Accounts • Flexible PTO • 401(k) + Company Match • Life Insurance, Pet insurance, and more