Payor Contract Integrity & Delegation Lead

Advanced Medical Management, Inc.; Long Beach (CA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Employer-paid HMO

Discounted dental and vision premiums

401(k) plan

Generous PTO

Tuition reimbursement

Job summary

A leading healthcare firm in California is seeking a highly analytical Manager, Payor Contract Integrity & Delegation Operations. This role ensures capitation payments and claims-based reimbursements are aligned with contracted terms. Responsibilities include managing discrepancies, validating system configurations, and coordinating with cross-functional teams. Ideal candidates should have significant experience in healthcare economics and strong project management abilities. Join us for a comprehensive benefits package that prioritizes your well-being and career growth.

Qualifications

• 5+ years of experience in payor contracting operations, healthcare economics, capitation reconciliation, delegated risk operations, or MSO finance.
• Strong working knowledge of capitated payment structures, risk-bearing provider contracts, and DOFR frameworks.
• Demonstrated experience managing cross-functional implementation projects.

Responsibilities

• Serve as primary liaison with payors to identify and resolve capitation discrepancies.
• Partner with Healthcare Economics and Finance to reconcile capitation models.
• Analyze payment variances and validate alignment to contracted rates.
• Support audit readiness related to delegated and capitated arrangements.

Skills

Analytical skills

Financial analysis

Project management

Excel proficiency

Education

Bachelor’s degree

Advanced degree

Job description

A leading healthcare firm in California is seeking a highly analytical Manager, Payor Contract Integrity & Delegation Operations. This role ensures capitation payments and claims-based reimbursements are aligned with contracted terms. Responsibilities include managing discrepancies, validating system configurations, and coordinating with cross-functional teams. Ideal candidates should have significant experience in healthcare economics and strong project management abilities. Join us for a comprehensive benefits package that prioritizes your well-being and career growth.