Job Description
The Sr Manager, Healthcare Payment Operations (internally: Sr. Manager, Performance Economics) will support Aledade’s Practice Payments Excellence Initiative as we transition to an automated payment processing system across all health plan contracts. Acting as the subject matter expert for contract payment terms, this role provides critical inputs such as mapping required fields for data ingestion and writing payment distribution logic for calculations. In addition, the position will own all payment reconciliation activities to support compliance and audit requirements.
Candidates should be comfortable working remotely/work from home anywhere within the US.
Primary Duties:
- Serve as the subject matter expert in interpreting payer agreements and practice participation terms to ensure accurate calculation and distribution of care coordination fees, quality bonuses, and other payments.
- Collaborate with the Provider Network Operations team to support the build of standard operating procedures, timelines, and workflows to clearly document the end-to-end process that will ensure timely execution of payments to practices. Provide inputs for mapping payment files, identifying required fields for data ingestion and defining payment calculation logic. Maintain reconciliation trackers to measure contract performance and support audit requests.
- Oversee the receipt, validation, and processing of payments based on contractual requirements. Collaborate across teams and with payers to resolve discrepancies. Process any payments that fall outside of the automation process.
- Partner with Accounting to ensure proper classification of payments by contract, line of business, and payment type.
- Ensure transparency of payment distributions for field teams and provide timely updates and timelines to market stakeholders via dashboards or other communication channels.
- Support for the development and execution of shared savings distribution formulas.
- Review payments processed by Data Analyst for accuracy.
Minimum Qualifications:
- Bachelor’s Degree in business, health administration, public policy, or related field.
- 5+ years of experience related to the business of healthcare.
- 1 + year management experience
- Proficiency in SQL, Microsoft Excel/Google Sheets
Preferred KSA’s:
- Deep knowledge of value based care and health plan payer contracts/payment models
- Solid understanding of accounting concepts related to payment reconciliation and accruals
- Proven ability to create and maintain accurate documentation that meets external audit requirements
- Ability to collaborate effectively with cross-functional teams and external partners
- Strong organizational skills with the ability to multitask, prioritize competing demands, and manage time effectively in a fast-paced environment
Who We Are:
Aledade, 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, 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, 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.
Privacy Policy: By applying for this job, you agree to Aledade’s Applicant Privacy Policy available at https://www.aledade.com/privacy-policy-applicants
We may use automated tools, including artificial intelligence (AI), to help organize and evaluate application materials. These tools support our recruiters and hiring managers by helping manage large applicant pools. Human judgment plays an essential role in our hiring process, including in the oversight and use of any automated tools. If you would like more information about our screening and hiring process, please contact us.
