Director, Payer Operations

Summary

Join Aledade as the Director, Payer Operations and lead the development and execution of key business processes to enhance efficiency and effectiveness in managing health plan contracts. Oversee two Managers and their teams, focusing on hiring, discipline, and performance management. Lead multiple operational initiatives, including Practice Rostering and policy development. Manage contract lifecycle management, ensuring efficient execution in collaboration with cross-functional teams. Establish reliable processes, enforce accuracy in contract participation cycles, and improve workflows. QA data in Salesforce and Plouton, and develop audit reporting for proactive issue detection. Collaborate with stakeholders to build systems and tools for roster maintenance, and represent business users in product development. Aledade offers a comprehensive benefits package including flexible work schedules, remote work options, health insurance, paid time off, parental leave, and more.

Requirements

• 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)

Responsibilities

• 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)
• 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
• 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

Preferred Qualifications

• Master’s Degree in healthcare or related field
• Experience working with value-based contracts
• Experience with Google Suite

Benefits

• 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