Payer Operations Analyst

Openkrill; United States; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Remote-friendly

Health insurance

Paid time off

Parental leave

Stock options

401(k)

Job summary

Aledade PBC is seeking a Payer Data Operations Analyst to ensure data quality and reliability across payer data pipelines. You will lead data triage, coordinate audits with payers, and collaborate with internal teams to resolve data issues that affect contract performance.

The role emphasizes cross-functional collaboration, strong SQL skills, and fluency with data platforms, BI tools, and file-transfer systems. A remote-first culture and healthcare domain focus shape the work environment.

Qualifications

• Bachelor’s Degree
• 4+ years of experience in data operations, analytics, product management, or related technical roles
• Intermediate SQL programming experience
• Technical fluency across various data platforms and tools (data warehouses, BI and visualization software, file-transfer systems, and workflow management tools)
• Demonstrated ability to navigate complex data environments and trace data flows across internal and external systems
• Proven track record of collaborating in cross-functional teams and communicating insights to stakeholders
• Proactive mindset with drive to understand system architecture and optimize processes

Responsibilities

• Identify, triage, route, and resolve data quality issues across 1,200+ payer data feeds
• Partner with payers and internal teams to address broken SFTP connections, delivery delays, and file transmission failures
• Coordinate clinical quality submission audits with payers and internal teams by managing audit documentation, organizing patient data files, and locating clinical evidence
• Maintain accurate contract metadata to ensure seamless downstream data integration
• Investigate and resolve manual data ingestion failures
• Collaborate with internal teams and payer partners to intake, investigate, route, and resolve data issues
• Communicate complex data findings clearly to diverse stakeholders
• Lead cross-functional data initiatives from discovery through implementation
• Serve as a subject matter expert on payer data analytics to optimize patient care and contract objectives
• Maintain SOPs for data issue triage, ingestion troubleshooting, and PSV audits
• Enhance long-term data reliability by addressing root causes and improving ingestion workflows

Job description

The Payer Data Operations Analyst ensures data quality, accuracy, and reliability across payer data pipelines to support value-based contract performance. This role applies technical data skills and cross-functional leadership to resolve complex data issues, build proactive monitoring solutions, and partner with internal teams and payers to continuously enhance end-to-end data integrity.

Primary Duties

Data Triage and Operations

• -Identify, triage, route, and resolve data quality issues across Aledade’s 1,200+ payer data feeds.
• -Partner with payers and internal teams to address broken SFTP connections, delivery delays, and file transmission failures.
• -Coordinate clinical quality submission audits with payers and internal teams by managing audit documentation, organizing patient data files, and locating clinical evidence in collaboration with the Quality Reporting team.
• -Maintain accurate contract metadata (i.e. contract names, TINs, and administrative details) to ensure seamless downstream data integration into reporting and product platforms.
• -Investigate and resolve manual care gap upload failures to ensure complete and accurate data ingestion.

Cross-Functional Collaboration

• -Collaborate with internal teams—including Payer Solutions, Product, Engineering, and Field Operations—and payer partners to intake, investigate, route, and resolve data issues.
• -Communicate complex data findings and technical concepts clearly to diverse technical and non-technical stakeholders.
• -Lead cross-functional data initiatives from discovery through implementation by mapping workflows, facilitating alignment, delivering actionable recommendations, and establishing clear task ownership and deliverables.
• -Serve as a subject matter expert on Aledade’s payer data, analyzing feed and metric anomalies to empower internal teams to optimize patient care and achieve contract objectives.

Program Management

• -Maintain standard operating procedures (SOPs) for data issue triage, clinical ingestion troubleshooting, and Primary Source Verification (PSV) audits.
• -Enhance long-term data reliability by addressing root causes, advocating for higher-quality payer feeds, and streamlining internal ingestion workflows.

Other duties as assigned

Minimum Qualifications

• -Bachelor’s Degree
• -4+ years of experience in data operations, analytics, product management, or related technical roles working with complex data within healthcare, product development, SaaS, or similar environments.
• -Intermediate SQL programming experience.
• -Technical fluency across various data platforms and tools, including data warehouses, BI and visualization software, file-transfer systems, and workflow management tools (i.e. Snowflake, Databricks, Tableau, SFTP, Jira).
• -Demonstrated ability to navigate complex data environments and trace data flows across internal and external systems to identify root causes.
• -Proven track record of collaborating in cross-functional teams with the ability to effectively communicate technical insights and business impact to diverse stakeholders.
• -Proactive and curious mindset with a drive to understand system architecture, independently navigate complex data ecosystems, and take initiative to continuously optimize processes.

Preferred Qualifications

• -Healthcare domain expertise, with a strong understanding of value-based care, Alternative Payment Models (APMs), Medicare, and non-MSSP quality measures.

Physical Requirements

• -Prolonged periods of sitting at a desk and working on a computer.

Who We Are:

Aledade PBC, 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, we've 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 value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service 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 you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

What Does This Mean for You?

At Aledade PBC, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness 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 work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well‑being 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 time-off 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 PBC, we don’t 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.