Manager, Payer Contracting

OpenLoop Health

About The Position

OpenLoop's mission is to bring care anywhere by powering telehealth solutions at scale. We are looking for a Manager, Payer Contracting to join our Clinical Compliance team and own the strategy, negotiation, and ongoing management of OpenLoop’s payer contracting portfolio. This role will be responsible for bringing structure and visibility to a complex, evolving contracting environment. You will assess and map our existing payer contracts across entities and markets, determine the appropriate group versus individual contracting approach, and personally lead negotiations and renegotiations with national and regional payers. You will partner closely with Revenue Cycle Management, Payer Enrollment, Finance, Clinical Operations, Compliance, Legal and other teams to ensure contracts are structured correctly and successfully implemented downstream. This is a highly hands-on role for someone who understands payer contracting from the provider perspective and is comfortable operating independently in an environment where the path may not already be defined.

Requirements

Bachelor’s degree or equivalent relevant experience.
6+ years of progressive experience in payer, managed care, or provider contracting, ideally within a multi-state or national healthcare organization.
Significant experience negotiating payer contracts from the provider side, with direct responsibility for sitting across the table from payer representatives and negotiating contract terms and reimbursement.
Demonstrated experience managing contracts across multiple payers, entities, markets, or states.
Strong understanding of group versus individual provider contracting, including the operational and enrollment considerations associated with each model.
Deep understanding of healthcare reimbursement methodologies, provider contracting, fee schedules, claims reimbursement, and managed care contracting.
Experience evaluating financial and operational data to prepare for and support payer negotiations.
Working knowledge of Medicare, Medicaid, Medicaid Managed Care Organizations, Medicare Advantage, and commercial payer contracting.
Experience partnering with Revenue Cycle Management, Payer Enrollment, Finance, Coding, Clinical Operations, and other stakeholders to operationalize payer agreements.
Ability to independently bring structure to incomplete or fragmented information, identify gaps, develop a path forward, and drive work through completion.
Ability to manage multiple complex priorities and sensitive deadlines with a high degree of autonomy.

Nice To Haves

Experience working within both a payer and provider organization, with a strong understanding of how contracting decisions impact each side.
Experience leading payer contracting for a national healthcare, telehealth, physician group, hospital, or other multi-state provider organization.
Experience with value-based contracting or alternative reimbursement arrangements.
Experience consolidating or restructuring payer agreements following acquisitions, entity changes, or organizational growth.
Familiarity with provider enrollment and credentialing platforms such as MDStaff, Medallion, or Verisys.
Familiarity with payer portals, healthcare billing systems, contract management tools, and workflow platforms such as Jira, Zendesk, or Zoho Desk.

Responsibilities

Own OpenLoop’s payer contracting portfolio, including the identification, organization, assessment, negotiation, implementation, renewal, and ongoing management of payer contracts.
Build a comprehensive inventory and contracting map across OpenLoop entities, identifying existing agreements, contracting entities, payer relationships, state requirements, renewal dates, fee schedules, and gaps requiring remediation.
Determine the appropriate contracting strategy across group-level and individual provider contracts, including when payers require different contracting 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 that support OpenLoop’s clinical and financial objectives.
Use utilization, reimbursement, coding, payer mix, and financial data to develop fact-based negotiation strategies and effectively represent OpenLoop at the negotiating table.
Partner with Revenue Cycle Management and coding stakeholders to understand services and codes being billed, identify contracting implications, and ensure agreements appropriately support OpenLoop’s care delivery model.
Collaborate with Payer Enrollment to ensure contracted entities, providers, state identifiers, and enrollment requirements are accurately aligned with payer agreements.
Coordinate with Revenue Cycle Management, Finance, Clinical Operations, Compliance, and other stakeholders to ensure negotiated contracts are implemented accurately into downstream systems and workflows.
Evaluate existing contracts to identify opportunities to consolidate, restructure, renegotiate, or transition agreements as OpenLoop's organizational structure and payer strategy evolve.
Support the integration of acquired or newly added businesses into OpenLoop’s broader payer contracting strategy, assessing existing payer relationships and determining the appropriate future-state contracting approach.
Maintain current knowledge of Medicare, Medicaid and Medicaid Managed Care, Medicare Advantage, and commercial reimbursement methodologies and contracting requirements.
Monitor contract performance, renewals, reimbursement changes, and payer-specific issues and proactively initiate renegotiations or corrective actions when needed.
Establish and maintain productive relationships with payer contracting representatives and resolve escalated contract-related issues.
Serve as OpenLoop’s subject matter expert for payer contracting, providing guidance to internal stakeholders and helping establish scalable contracting processes, documentation, and operating standards.
Lead payer contracting projects independently, moving quickly to establish alignment across stakeholders and drive decisions through implementation.
Other duties as assigned.