Associate Director – Payer and Clinical Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of the onboarding process for each new payer, including managing timelines, processes, and collaborative efforts across functions.

• Ensure smooth operation of existing payer functions while addressing any operational issues that arise.

• Oversee efficient accounts receivable processes for payers, including electronic funds transfer setup, payment scheduling, eligibility for sub-plan services, and system updates to allowable amounts.

• Manage licensing and credentialing for clinical services, including the credentialing process for IBCLC.

• Lead the organization’s responses to audits, site evaluations, and license renewals.

• Identify and implement best practices for compliance throughout Babylist Health.

• Oversee the entire process of payer transitions from start to finish.

• Establish and maintain visibility into performance metrics at the payer level.

• Program-manage daily business reporting and monitoring tasks.

• Program-manage the operational aspects of new initiatives, including the introduction of new DME types and lines of business.

• Supervise and develop two direct reports.

• Collaborate effectively across teams, including billing/RCM, legal, product development, and payer contracting teams.

⛳️ Requirements

• Proven experience managing payer operations on a large scale across multiple contract types or service lines.

• In-depth understanding of healthcare licensing and credentialing, encompassing state licensure, site inspections, payer-level credentialing, and IBCLC credentialing.

• Experience in developing and maintaining operational relationships directly with payers.

• Familiarity with multi-state regulatory compliance requirements.

• Background in managing both commercial and Medicaid payer operations, including Medicaid expansion into new states.

• Capability to establish direction and articulate requirements clearly.

• Strong skills in people management, coaching, and performance evaluation.

• Aptitude for creating processes in environments characterized by ambiguity and rapid changes.

• Experience navigating within a large, matrixed organization.

• Proven ability to collaborate with billing/RCM, legal, product development, customer support, and payer contracting teams.

• Proficient in utilizing AI tools in everyday tasks.

🏝️ Benefits

• Competitive salary with significant opportunities for career growth.

• Opportunities for career advancement based on performance.

• Company-paid health, dental, and vision insurance.

• Retirement savings plan with employer matching contributions.

• Flexible spending accounts available.

• Generous paid parental leave and paid time off.

• Winter Wonder Week: the entire company enjoys a paid week off at the end of the year.

• Remote work stipend to help set up your home office.

• Benefits supporting physical, mental, and emotional well-being, parenting, childcare, and financial planning.

• Access to advanced tools like Claude and ChatGPT from day one.