Manager, Payer Contracting

OpenLoop Health

1d•Hybrid

About The Position

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.

Requirements

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
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

Nice To Haves

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

Responsibilities

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