Payer Contracting Manager – Telehealth Scale

OpenLoop Health; United States; Remote; USD 120,000 - 180,000; Full time

Benefits offered by this job

Medical, Dental & Vision

Flexible Spending / Health Savings

PTO and holidays

401(k)

Job summary

OpenLoop Health is seeking a Manager, Payer Contracting to lead strategy, negotiations, and ongoing management of our payer portfolio in a dynamic telehealth setting. You will map contracts across entities and markets, decide group vs.

individual contracting, and negotiate with national and regional payers, coordinating with Revenue Cycle Management, Payer Enrollment, Finance, and Legal. The role requires independence, deep understanding of Medicare/Medicaid reimbursement, and the ability to

Qualifications

• Bachelor’s degree or equivalent relevant experience.
• 6+ years of progressive experience in payer, managed care, or provider contracting across states.
• Experience negotiating payer contracts from the provider side.
• Experience managing contracts across multiple payers, entities, markets, or states.
• Strong understanding of group versus individual provider contracting.
• Working knowledge of Medicare, Medicaid, Medicare Advantage, and commercial payer contracting.
• Ability to independently bring structure to incomplete or fragmented information.

Responsibilities

• Own OpenLoop’s payer contracting portfolio, including identification, organization, assessment, negotiation, implementation, renewal, and ongoing management of payer contracts.
• Build a comprehensive inventory and contracting map across OpenLoop entities, identifying agreements, contracting entities, payer relationships, state requirements, renewal dates, fee schedules, and gaps.
• Determine the appropriate contracting strategy across group-level and individual provider contracts, including when payers require different structures by entity, provider group, market, or state.
• Personally lead payer negotiations and renegotiations, serving as OpenLoop’s primary contracting representative with national and regional health plans.
• Negotiate reimbursement rates, fee schedules, contract terms, and other financial arrangements supporting OpenLoop’s objectives.
• Use utilization, reimbursement, coding, payer mix, and financial data to develop fact-based negotiation strategies.
• Partner with Revenue Cycle Management and coding stakeholders to understand services and codes billed and ensure contracts support OpenLoop’s care model.
• Collaborate with Payer Enrollment to align contracted entities and enrollment requirements with payer agreements.
• Coordinate with Revenue Cycle Management, Finance, Clinical Operations, and Compliance to implement negotiated contracts downstream.
• Evaluate existing contracts to identify opportunities to consolidate or restructure as OpenLoop evolves.
• Support integration of acquired or added businesses into payer contracting strategy.
• Maintain knowledge of Medicare, Medicaid and related reimbursement methodologies.
• Monitor contract performance and initiate renegotiations when needed.
• Establish and maintain relationships with payer contracting representatives.

Skills

Payer contracting

Negotiation

Healthcare policy

Data analysis

Cross-functional collaboration

Multi-state contracting

Leadership

Education

Bachelor’s degree or equivalent

Tools

Jira

Zendesk

Zoho Desk

Job description

OpenLoop Health is seeking a Manager, Payer Contracting to lead strategy, negotiations, and ongoing management of our payer portfolio in a dynamic telehealth setting. You will map contracts across entities and markets, decide group vs.

individual contracting, and negotiate with national and regional payers, coordinating with Revenue Cycle Management, Payer Enrollment, Finance, and Legal. The role requires independence, deep understanding of Medicare/Medicaid reimbursement, and the ability to