Manager, Payer Contracting

🔥 3 hours ago

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OpenLoop

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2020

💼 Consulting

⚖️ Legal

📦 Logistics

💰 $15M Series A - OpenLoop Health on 2023-03

Consulting • Legal • Logistics

OpenLoop is a white-label telehealth platform and managed services provider that helps organizations launch and scale virtual care programs. It combines SaaS-based, brandable technology (scheduling, booking, payments, EHR/API integrations) with clinical staffing, credentialing, payer coverage and RCM, regulatory/legal support, and 24/7 patient support. OpenLoop serves health plans, hospitals and health systems, retailers, employers and digital health companies with AI-powered operations, a nationwide clinician network and broad insurance coverage including Medicare and Medicaid.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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