Job description
The Director, Payer Operations is accountable for developing and executing on key business processes to increase efficiency and effectiveness managing a complex, diverse set of health plan contracts.
Primary Duties:
Leadership & Execution
Oversees the work of two Managers and the daily operations of their Teams including, but not limited to, hiring, disciplining, and performance management.
Lead and execute across multiple, complex operational initiatives including Practice Rostering establishing a high confidence approach for understanding practice participation in value-based contracts; and, develop other critical policies and procedures.
Lead and manage a cross-functional team focused on contract lifecycle management ensuring the efficient and effective execution of the contract lifecycle in partnership with a cross functional Aledade team (Strategic Payer Partnerships, Legal, Product, etc)
Operations Optimization
Establish reliable processes and enforce accuracy across all steps in every practice’s contract participation cycle (including eligibility/sales requirements, roster submission, post-submission reconciliation and withdrawal submission to completion).
Map and improve current state workflows from end-to-end for existing and new/complex flows
QA data in Salesforce (“participation intentions” incl withdrawals) and our internal database, Plouton (“actual participation”), and approve the logic for translating between the two.
Embed quality assurance across the organization. Establish audit reporting for detecting issues proactively. Run proactive audit reports for each step in the process. Establish error-intake process.
Convene the right committee to run-to-ground any discrepancies surfaced in error/field reports. Coordinate with the appropriate teams to ensure data is accurate and reflects the roster shared with the practice.
Collaboration with Key Stakeholders
Collaborate with key stakeholders to build key, cross-functional systems + tools to create and maintain reliable rosters; Partner with Product & Tech on tools/UIs/error reports to support accurate data capture & usability
Represent Business users in Product design and development (ex. Ironclad, Keystone, and Salesforce).
Other duties as assigned
Minimum Qualifications:
- Bachelor’s degree in healthcare or related field
- A minimum of 10 years experience in health care operations; Plus 6-8 years management experience.
- Strong leadership and collaboration skills with the ability to influence and engage key stakeholders at all levels.
- Strong organization skills and attention to detail
- Exceptional analytical skills to quickly interpret data, highlight root causes, and translate into meaningful action
- Proficiency in contract management systems (i.e. Salesforce)
- Strong communication skills (i.e. verbal, written, presentation)
Preferred Qualifications:
- Master’s Degree in healthcare or related field
- Experience working with value-based contracts
- Experience with Google Suite
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.
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