Payer Integration Manager

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

📋 Description

• Oversee a large volume of simultaneous health plan integration workflows, ensuring effective coordination between internal teams and external carrier technical representatives.

• Lead the complete implementation process for payer integrations, addressing any communication or technical challenges to ensure the successful completion of high-priority data configurations.

• Examine intricate backend data structures, implementation protocols, and integration components—including 837/835 transaction loops, electronic funds transfers (EFT), and provider configuration profiles—to identify the most efficient deployment strategies.

• Detect integration, billing, and system configuration risks early in the implementation phase and proactively apply mitigation strategies.

• Collaborate closely with cross-functional technical and non-technical teams to synchronize external payer systems with our internal revenue cycle framework.

• Maintain a thorough and current understanding of funding structures, benefit designs, compliance obligations, and industry-standard integration practices.

• Implement proactive revenue cycle strategies during the onboarding process to ensure accurate upstream configuration, healthy billing practices, and strong financial results.

• Actively contribute to the ongoing enhancement of onboarding documentation, deployment checklists, and standard operating procedures to improve our operational efficiency.

⛳️ Requirements

• 3-5 years of relevant professional experience in managing integrations, implementations, or technical operations with health insurance payers and carriers.

• Proven data proficiency, including hands-on experience with querying data in Snowflake, building or utilizing reporting in Looker, and interpreting metrics to inform decision-making.

• Strong business acumen and analytical abilities, with a demonstrated capability to assess dashboard metrics, uncover data insights, and convert reports into actionable plans.

• Established proficiency in executing complex, high-volume data integration tasks and projects autonomously with minimal oversight.

• Extensive knowledge of fundamental health insurance concepts, payer funding structures, health plan benefit designs, and carrier networks.

• Strong technical knowledge of healthcare EDI transaction infrastructure and standards, particularly 837 and 835 claim files, billing loops, in-network processing, and provider configuration profiles.

• Solid understanding of general revenue cycle management (RCM) principles, including claims processing, adjudication, billing regulations, and clearinghouse operations.

• Excellent communication and collaboration skills, with a history of effectively conveying technical integration details to non-technical stakeholders.

• Familiarity with HIPAA regulations and related compliance requirements regarding electronic healthcare transactions and protected health information (PHI).

• A Bachelor’s degree in Health Information Management, a related field, or equivalent practical experience is preferred.

🏝️ Benefits

• Health, Dental, and Vision benefits commence on your first day at Spring. You and your dependents also gain access to One Medical accounts. HSA and FSA plans are available, with Spring contributing up to $1K for HSAs, depending on your plan type.

• Employer-sponsored 401(k) match of up to 2% for retirement planning.

• A yearly allocation of no-cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents.

• We provide competitive paid time off policies including vacation, sick leave, and company holidays.

• After 6 months with Spring, we offer parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents.

• Access to Noom, a psychology-based weight management program tailored to your individual needs and goals.

• Access to fertility care support through Carrot, including a $4,000 reimbursement for related fertility expenses.

• Access to Wellhub, which connects employees to optimal options for fitness, mindfulness, nutrition, and sleep in one subscription.

• Access to BrightHorizons, providing sponsored child care, back-up care, and elder care.

• Up to $1,000 in Professional Development Reimbursement each year.

• $200 per year in donation matching to support your favorite causes.