Manager, Payer Contracting

OpenLoop Health, Inc.; Des Moines (IA); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

Medical, Dental, and Vision plans

Flexible Spending/Health Savings

Flexible PTO

401(k) + Company Match

Life Insurance, Pet insurance, and and

Job summary

OpenLoop Health, Inc. is seeking a Manager of Payer Contracting to lead contracting, negotiations, and renegotiations for payer agreements.

This role can be remote or based at our Des Moines, IA HQ, and works within the Clinical Compliance Team alongside the Senior Director. You will serve as a subject-matter expert for payer contracting, collaborating across Billing, Finance, IT, and Clinical Operations to ensure timely contract implementation and renewals, while supporting a learning

Qualifications

• Bachelor’s Degree is required.
• 4+ years in managed care contracting in a provider or payer setting.
• Strong understanding of payer contract reimbursement and analytic modeling.
• Experience with value-based contracting.
• Ability to manage multiple tasks and support teammates under deadlines.
• Knowledge of payer contracting, pricing, rebates, and healthcare regulations.

Responsibilities

• Acquire, coordinate, and analyze payer contracts.
• Negotiate fee schedules favorable to the organization.
• Collaborate with RevOps, Billing/Coding, Finance, IT, and Clinical Ops on contract updates.
• Monitor renewals and renegotiate contracts on renewal.
• Maintain knowledge of Medicare, Medicaid, and commercial payment methodologies.
• Coordinate fee schedule development with financial models.

Skills

Payer contracting

Negotiation

Managed care contracting

Analytic modeling

Billing systems understanding

Education

Bachelor’s Degree

Tools

MDStaff

Medallion

Verisys

Jira

ZenDesk

Zoho Desk

Job description

About OpenLoop

OpenLoop was co-founded by CEO, Dr. Jon Lensing, and COO, Christian Williams, with the vision to bring care anywhere. Our telehealth support solutions are thoughtfully designed to streamline and simplify go-to-market care delivery for companies offering meaningful virtual support to patients across an expansive array of specialties, in all 50 states.

About the Role

OpenLoop’s mission is to bring care anywhere by powering telehealth solutions at scale.OpenLoop is looking for a Manager of Payer Contracting to join our team remotely or in our HQ located in Des Moines, Iowa. This role will be a member of the Clinical Compliance Team, collaborating closely with the Senior Director, Clinical Compliance.The Payer Contract Manager will be responsible for all duties related to managing payer contracts, negotiations and renegotiations of new and existing payer contracts. Additionally this position is expected to be a SME for Payer Contracting and assist in fostering a learning atmosphere for other team members.

What You\'ll Do

• 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

Who You Are

• 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

Our Benefits

In addition, for salaried positions you would also be eligible for:

• Medical, Dental, and Vision plans

• Flexible Spending/Health Savings Accounts

• Flexible PTO

• 401(k) + Company Match

• Life Insurance, Pet insurance, and more

Our Company

We have a relatively flat organizational structure here at OpenLoop. Everyone is encouraged to bring ideas to the table and make things happen. This fits in well with our core values of Autonomy, Competence and Belonging, as we want everyone to feel empowered and supported to do their best work.

Sound like a good fit? We’d love to meet you.