OpenLoop is looking for a Payer Contract Manager to join our team remotely. This role will be a member of the Credentialing Team, collaborating closely with the Senior Director of Credentialing, Licensing & 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.
About the Role
Responsibilities include, but are not limited to:
- Development, coordination and analysis of payer contracts
- Secure and maintain credentialing delegation agreements with payers.
- Negotiation of payment terms and rates for new and existing contracts efficiently and effectively that are favorable for the organization
- Collaboration with the Credentialing team to ensure contracts are appropriately identified, negotiated, implemented, audited and renegotiated in a timely manner
- Collaboration with other functional areas of the organization to ensure payer contracts are negotiated and 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 payment methodologies, and Commercial payment methodologies
- Fee schedule development utilizing financial models and analysis in negotiating rates with Payers
- Manage and oversee all payers and markets of assigned geographic area
- May serve as a liaison internally between Billing/Coding, Finance, Information Technology, and Clinical Operations as it relates to MCO updates and changes
- Monitor renewals for contacts within assigned territory and renegotiate contracts as appropriate upon renewal
- Establish productive professional relationships with Payer Negotiators or 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
OpenLoop was co-founded by CEO, Dr. Jon Lensing, and COO, Christian Williams, with the vision to bring healing anywhere. Our telehealth support solutions are thoughtfully designed to streamline and simplify go-to-market care delivery for companies offering meaningful virtual support to patients across an expansive array of specialties, in all 50 states.
Our Company Culture
We have a relatively flat organizational structure here at OpenLoop. Everyone is encouraged to bring ideas to the table and make things happen. This fits in well with our core values of Autonomy, Competence and Belonging, as we want everyone to feel empowered and supported to do their best work.
In addition to competitive salaries, this role includes:
- Unlimited PTO
- Medical, Dental and Vision
- 401K Program
- Flexible Schedule and Hybrid Office
- The chance to change the future of medicine
Sound like a good fit? We’d love to meet you.
- 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
- 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
- Proficiency with computer data entry and Microsoft Office applications: SharePoint, Microsoft Excel, etc
- Ability to adapt and navigate business related software
- Ability to meet sensitive deadlines, organize workload with limited supervision