Payer Operations Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 10%

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Aledade, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2014

🏥 Healthcare

⚕️ Healthcare Insurance

🏢 Enterprise

Healthcare • Healthcare Insurance • Enterprise

Aledade, Inc. is a public benefit corporation that operates as the largest network of independent primary care practices in the United States. The company specializes in Accountable Care Organizations (ACOs), which help primary care practices and health centers improve patient outcomes and generate sustainable revenue through value-based care solutions. Aledade offers data insights, support, and business solutions to achieve sustainability and clinical autonomy. It collaborates with a wide range of healthcare providers, including primary care practices, community health centers, and network ACOs, ensuring improved quality of care and patient satisfaction. With operations in 45 states and affiliations with over 20,000 clinicians serving more than 2. 5 million patients, Aledade is committed to reducing care fragmentation and enhancing the overall quality of life for clinicians and patients alike.

📋 Description

• Identify, triage, route, and resolve data quality issues across 1,200+ payer data feeds • Partner with payers and internal teams to address broken SFTP connections, delivery delays, and file transmission failures • Coordinate clinical quality submission audits by managing audit documentation, organizing patient data files, and locating clinical evidence • Maintain accurate contract metadata, including contract names, TINs, and administrative details • Investigate and resolve manual care gap upload failures • Collaborate with Payer Solutions, Product, Engineering, Field Operations, and payer partners to resolve data issues • Communicate complex data findings and technical concepts to technical and non-technical stakeholders • Lead cross-functional data initiatives from discovery through implementation • Serve as a subject matter expert on payer data and analyze feed and metric anomalies • Maintain SOPs for data issue triage, clinical ingestion troubleshooting, and Primary Source Verification audits • Address root causes, improve payer feed quality, and streamline internal ingestion workflows • Perform other duties as assigned

🎯 Requirements

• Bachelor’s Degree • 4+ years of experience in data operations, analytics, product management, or related technical roles working with complex data within healthcare, product development, SaaS, or similar environments • Intermediate SQL programming experience • Technical fluency across data warehouses, BI and visualization software, file-transfer systems, and workflow management tools, including Snowflake, Databricks, Tableau, SFTP, and Jira • Ability to navigate complex data environments and trace data flows across internal and external systems to identify root causes • Proven ability to collaborate in cross-functional teams and communicate technical insights and business impact to diverse stakeholders • Proactive and curious mindset with the ability to understand system architecture, navigate complex data ecosystems, and optimize processes • Healthcare domain expertise with understanding of value-based care, Alternative Payment Models (APMs), Medicare, and non-MSSP quality measures (preferred) • Prolonged periods of sitting at a desk and working on a computer

🏖️ Benefits

• Flexible work schedules and the ability to work remotely are available for many roles • Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners • Robust time-off plan (21 days of PTO in your first year) • Two paid volunteer days and 11 paid holidays • 12 weeks paid parental leave for all new parents • Six weeks paid sabbatical after six years of service • Educational Assistant Program and Clinical Employee Reimbursement Program • 401(k) with up to 4% match • Stock options