Manager, Payer Contracting

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OpenLoop

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 2020

☁️ SaaS

🤝 B2B

🏢 Entreprise

💰 €15 000 000 Series A - OpenLoop Health en 2023-03

SaaS • B2B • Enterprise

OpenLoop est une plateforme de télésanté en marque blanche et un fournisseur de services gérés qui aide les organisations à lancer et à développer des programmes de soins virtuels. Elle combine une technologie SaaS personnalisable (planification, réservation, paiements, intégrations EHR/API) avec des services de dotation clinique, de validation des compétences, de couverture par les payeurs et de gestion du cycle de revenus (RCM), ainsi qu'un support réglementaire/légal et une assistance patient 24/7. OpenLoop sert des régimes de santé, des hôpitaux et des systèmes de santé, des détaillants, des employeurs et des entreprises de santé numérique avec des opérations alimentées par l'IA, un réseau de cliniciens à l'échelle nationale et une large couverture d'assurance incluant Medicare et Medicaid.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

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