Manager, Payer Contracting

About the role

The Manager, Payer Contracting at Openloop Health owns the full lifecycle of payer agreements from initial acquisition through ongoing optimization. This role is accountable for securing and maintaining group-level contracts with payers, including delegated payer contracts where able, leveraging OpenLoop's NCQA Accreditation as a strategic asset. The hire will negotiate fee schedules for new and existing contracts to ensure terms are favorable, sustainable, and aligned with OpenLoop's telehealth mission. They will analyze contract terms and conditions to facilitate accurate implementation and compliance across all product lines. This position serves as a subject matter expert for payer contracting and actively supports a learning environment for other team members. The role requires close collaboration with cross-functional partners to ensure payer contracts create a positive impact on company objectives. Additionally, this hire will monitor contract expirations and drive timely renewals while resolving escalated payer-specific issues.

Key facts

What you'll do

• Acquire, coordinate, and analyze payer contracts to identify opportunities and risks across the portfolio.
• Secure and maintain group-level contracts with payers, including delegated payer contracts where able, relying on OpenLoop's NCQA Accreditation.
• Negotiate fee schedules for new and existing contracts efficiently and effectively to protect organizational value.
• Collaborate with the Payer Enrollment and Revenue Cycle Management teams to ensure contracts are identified, implemented, and reviewed in a timely manner.
• Work with other functional areas of the organization to structure payer contracts in a way that generates positive business impact.
• Review contract terms and conditions to enable precise implementation and adherence.
• Sustain current knowledge of Medicare reimbursement methodologies, State Medicaid payment methodologies, and commercial payment approaches including commercial managed care plans.
• Coordinate fee schedule development with the RevOps team using financial models and analysis during payer rate negotiations.
• Manage and oversee all group-level payer contracts to ensure accuracy and compliance.
• Act as a liaison internally between Billing, Coding, Finance, Information Technology, and Clinical Operations for group payer contract changes.
• Monitor contract renewal dates and renegotiate contracts as appropriate when renewals occur.
• Establish productive professional relationships with payer contract representatives to facilitate efficient execution.
• Resolve escalated contract-specific payer issues to maintain continuity and service levels.
• Assist with analysis of payer mix and rate structure to support strategic decision-making.
• Maintain working knowledge of billing databases to support accurate reporting.
• Manage special projects and other duties as required to support the team.

Requirements

• Hold a Bachelor's Degree from an accredited institution.
• Bring 4 or more years of prior experience in managed care contracting within a provider or payer setting.
• Demonstrate an extensive understanding of payer contract reimbursement and analytic modeling techniques.
• Have direct value-based contracting experience in a relevant environment.
• Show the ability to manage multiple tasks simultaneously while coaching team members in routine daily activities.
• Maintain a working knowledge of current policies and guidelines that affect contracts, pricing, rebates, legislative regulations, and the managed care environment.
• Possess knowledge of provider contracting, financial arrangements, and fee schedules, including healthcare reimbursement methodologies and preferred guidelines.
• Show familiarity with claims processing systems and associated guidelines.
• Demonstrate proficiency with computer data entry, GSuite, payer portal navigation, and provider data management systems such as MDStaff, Medallion, or Verisys.
• Exhibit experience with ticketing platforms such as Jira, ZenDesk, or Zoho Desk.
• Display the ability to adapt and navigate various business-related software applications.
• Demonstrate the capacity to meet sensitive deadlines and organize workload with limited supervision.

Nice to have

• Preferred knowledge of telehealth-specific contracting nuances and payer policies relevant to virtual care delivery.

Practical notes

• This is a full-time role.
• The position is remote with no travel required.
• No specific visa sponsorship details or deadlines are published on this page.