Manager, Payer Contracting

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OpenLoop

WebsiteLinkedInAlle Stellen

201 - 500 Mitarbeiter

Gegründet 2020

💼 Beratung

⚖️ Rechtswesen

📦 Logistik

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

Consulting • Legal • Logistics

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

• Acquire, coordinate, and analyze payer contracts • Secure and maintain group-level and delegated payer contracts • Negotiate favorable fee schedules for new and existing contracts • Collaborate with Payer Enrollment and RCM teams to identify, negotiate, implement, and review contracts • Collaborate with functional teams to structure payer contracts for positive company impact • Review contract terms and conditions for accurate implementation • Maintain knowledge of Medicare, State Medicaid/MCO, and Commercial/MA reimbursement methodologies • Coordinate fee schedule development with RevOps using financial models and analysis • Manage and oversee all group-level payer contracts • Liaise with Billing/Coding, Finance, IT, and Clinical Operations on payer contract updates • Monitor renewals and renegotiate contracts as appropriate • Establish relationships with payer contract representatives • Resolve escalated payer contract issues • Analyze payer mix and payer contract rate structures • Maintain working knowledge of the billing database for reporting • Manage special projects and other assigned duties • Serve as a payer contracting subject-matter expert and support team learning

🎯 Anforderungen

• Bachelor’s Degree • 4+ years of 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 with routine daily activities • Working knowledge of policies and guidelines affecting contracts, pricing, rebates, and legislative regulations in managed care • Knowledge of provider contracting, financial arrangements, fee schedules, healthcare reimbursement methodologies, and guidelines preferred • Knowledge of claims processing systems and guidelines • Proficiency with computer data entry and GSuite • Experience navigating payer portals • Experience with provider data management systems such as MDStaff, Medallion, or Verisys • Experience with ticketing platforms such as Jira, Zendesk, or Zoho Desk • Ability to adapt to and navigate business software • Ability to meet sensitive deadlines and organize workload with limited supervision • Must answer the employer's visa sponsorship question during application

🏖️ Vorteile

• Medical, Dental, and Vision plans • Flexible Spending/Health Savings Accounts • Flexible PTO • 401(k) + Company Match • Life Insurance • Pet insurance • Autonomy, Competence and Belonging-focused work culture