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OpenLoop is a telehealth platform that powers virtual care delivery at scale across all 50 states. The Manager of Payer Contracting will join the Clinical Compliance Team, reporting to the Senior Director of Clinical Compliance, and own all aspects of payer contract management, negotiation, and strategy.
Key responsibilities include acquiring and analyzing payer contracts; securing and maintaining group-level contracts with payers, including delegated arrangements leveraging OpenLoop's NCQA Accreditation; negotiating fee schedules for new and existing contracts to optimize organizational outcomes; and collaborating with Payer Enrollment, RCM, Finance, and RevOps teams to ensure contracts are properly identified, implemented, and reviewed. You will serve as the subject matter expert on payer contracting, mentor team members, maintain expertise in Medicare, Medicaid (including MCOs), and commercial reimbursement methodologies, and manage contract renewals and escalations.
The role requires deep knowledge of managed care contracting, payer reimbursement models, value-based contracting, and healthcare financial arrangements. You will coordinate fee schedule development using financial models, maintain relationships with payer representatives, monitor contract performance, and resolve complex contract issues. Additional responsibilities include analyzing payer mix and rate structures, maintaining working knowledge of billing systems, and managing special projects as needed.
You bring 4+ years of managed care contracting experience in a provider or payer setting, a bachelor's degree, and extensive understanding of payer reimbursement and analytic modeling. You are proficient with GSuite, payer portals, provider data management systems (MDStaff, Medallion, Verisys), and ticketing platforms (Jira, ZenDesk, Zoho Desk). You can manage multiple priorities simultaneously, adapt to business software, meet sensitive deadlines, and work with limited supervision. Knowledge of claims processing systems and healthcare reimbursement guidelines is preferred.
