Payer Operations Leader — Scale & Transformation

VAXCARE LLC; Orlando (FL); On-site; USD 150,000 - 210,000; Full time

Job summary

VaxCare LLC is seeking a Sr. Director of Payer Operations to build and scale the contract abstraction, enrollment, and reimbursement functions.

You will set the operating model, governance and controls to ensure accurate translation of contracts into systems and workflows. You will lead cross-functional efforts with Market Access, RCM, Product, Technology and Finance to drive faster go-lives, reduce denials and improve reimbursement accuracy across networks, providers and payers.

Qualifications

• 10+ years in payer operations and related areas.
• Strong knowledge of enrollment, credentialing, reimbursement and contract terms.
• Proven cross-functional leadership across payer, product, technology and finance.

Responsibilities

• Own the operational handoff of executed payer contracts, amendments and reimbursement changes.
• Maintain a repository of contracts, amendments, fee schedules and effective dates.
• Translate payer requirements into implementation plans with clear owners and milestones.
• Provide input during contract discussions and resolve post-contract defects.
• Own provider enrollment, re-enrollment and credentialing, CAQH and roster maintenance.
• Track enrollment status, defects and readiness risks; resolve issues before impacting reimbursements.
• Translate contractual terms into billing/configuration requirements and sign-off processes.
• Lead fee-schedule loading, billing-rule configuration and payer identifier setup.
• Partner with Product and Technology to improve configuration capabilities and reduce manual effort.
• Monitor reimbursement variances and drive corrective action with RCM and analytics.
• Establish payer audit intake and governance with cross-functional teams.

Skills

Payer operations

Provider contracting

Enrollment & credentialing

Reimbursement operations

Leadership

Cross-functional collaboration

Tools

CAQH

Job description

VaxCare LLC is seeking a Sr. Director of Payer Operations to build and scale the contract abstraction, enrollment, and reimbursement functions.

You will set the operating model, governance and controls to ensure accurate translation of contracts into systems and workflows. You will lead cross-functional efforts with Market Access, RCM, Product, Technology and Finance to drive faster go-lives, reduce denials and improve reimbursement accuracy across networks, providers and payers.