The Director, Payer Operations is accountable for developing and executing on key business processes to increase efficiency and effectiveness managing a complex, diverse set of health plan contracts.
Primary Duties:
- Leadership & Execution
- Lead and execute across multiple, complex operational initiatives including Practice Rostering establishing a high confidence approach for understanding practice participation in value-based contracts; and, develop other critical policies and procedures.
- Lead and manage a cross-functional team focused on contract lifecycle management ensuring the efficient and effective execution of the contract lifecycle in partnership with a cross functional Aledade team (Strategic Payer Partnerships, Legal, Product, etc)
- Lead a team to ensure operational excellence , productivity, and a strong team culture
- Operations Optimization
- Establish reliable processes and enforce accuracy across all steps in every practice’s contract participation cycle (including eligibility/sales requirements, roster submission, post-submission reconciliation and withdrawal submission to completion).
- Map and improve current state workflows from end-to-end for existing and new/complex flows
- QA data in Salesforce (“participation intentions” incl withdrawals) and our internal database, Plouton (“actual participation”), and approve the logic for translating between the two.
- Embed quality assurance across the organization. Establish audit reporting for detecting issues proactively. Run proactive audit reports for each step in the process. Establish error-intake process.
- Convene the right committee to run-to-ground any discrepancies surfaced in error/field reports. Coordinate with the appropriate teams to ensure data is accurate and reflects the roster shared with the practice.
- Collaboration with Key Stakeholders
- Collaborate with key stakeholders to build key, cross-functional systems + tools to create and maintain reliable rosters; Partner with Product & Tech on tools/UIs/error reports to support accurate data capture & usability
- Represent Business users in Product design and development (ex. Ironclad, Keystone, and Salesforce).
- Other duties as assigned
Minimum Qualifications:
- Bachelor’s degree in healthcare or related field
- A minimum of 10 years experience in health care operations including payer contracting and/or provider credentialing; Plus 6-8 years management experience.
- Strong leadership and collaboration skills with the ability to influence and engage key stakeholders at all levels.
- Strong organization skills and attention to detail
- Exceptional analytical skills to quickly interpret data, highlight root causes, and translate into meaningful action
- Proficiency in contract management systems (i.e. Salesforce)
- Strong communication skills (i.e. verbal, written, presentation)
Preferred Qualifications:
- Master’s Degree in healthcare or related field
- Experience working with value-based contracts
- Experience with Google Suite