Sr. Manager, Healthcare Payment Operations (Remote)

Aledade • Nashville, TN

10d • Remote

About The Position

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.

Requirements

• 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

Nice To Haves

• 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

Responsibilities

• 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.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level