Director Payer Operations Remote
Director Payer Operations Remote
Posted on :
01-05-2025
Employer Active
1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
01-05-2025
Job Description
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 &
- Oversees the work of two Managers and the daily operations of their Teams including but not limited to hiring disciplining and performance management.
- Lead and execute across multiple complex operational initiatives including Practice Rostering establishing a high confidence approach for understanding practice participation in valuebased contracts; and develop other critical policies and procedures.
- Lead and manage a crossfunctional team focused on contract lifecycle management ensuring the efficient and effective of the contract lifecycle in partnership with a cross functional Aledade team (Strategic Payer Partnerships Legal Product etc)
- Operations Optimization
- Establish reliable processes and enforce accuracy across all steps in every practices contract participation cycle (including eligibility/sales requirements roster submission postsubmission reconciliation and withdrawal submission to completion).
- Map and improve current state workflows from endtoend 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 errorintake process.
- Convene the right committee to runtoground 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 crossfunctional 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:
- Bachelors degree in healthcare or related field
- A minimum of 10 yearsexperience in health care operations; Plus 68 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:
- Masters Degree in healthcare or related field
- Experience working with valuebased contracts
- Experience with Google Suite
Who We Are:
Aledade a public benefit corporation exists to empower the most transformational part of our health care landscape independent primary care. We were founded in 2014 and since then weve become the largest network of independent primary care in the country helping practices health centers and clinics deliver better care to their patients and thrive in valuebased care. Additionally by creating valuebased contracts across a wide variety of health plans we aim to flip the script on the traditional feeforservice model. Our work strengthens continuity of care aligns incentives and ensures primary care physicians are paid for what they do best keeping patients healthy. If you want to help create a health care system that is good for patients good for practices and good for society and if youre eager to join a collaborative inclusive and remotefirst culture youve come to the right place.
What Does This Mean for You
At Aledade you will be part of a creative culture that is driven by a passion for tackling complex issues with respect openmindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences interests backgrounds beliefs and achievements to their work and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support worklife balance and enjoyment we offer the following comprehensive benefits package designed for the overall wellbeing of our team members:
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 timeoff 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
And much more!
At Aledade we dont just accept differences we celebrate them! We strive to attract develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit qualifications performance and business needs. All qualified candidates will receive consideration for employment without regard to age race color national origin gender (including pregnancy childbirth or medical conditions related to pregnancy or childbirth) gender identity or expression religion physical or mental disability medical condition legally protected genetic information marital status veteran status or sexual orientation.
Privacy Policy:By applying for this job you agree to AledadesApplicant Privacy Policy available at Experience:
Director
Employment Type
Full-Time
Key Skills
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