Program Manager, Payer Operations

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

📋 Description

• Monitor ongoing payer issues from start to finish, ensuring clear ownership, visibility, and accountability across various teams until resolution is achieved.

• Enhance revenue cycle management (RCM) efficiency and effectiveness to boost revenue performance and provide a superior experience for Alma providers and their clients.

• Facilitate connections among stakeholders, subteams, and workflows within internal operations, highlighting interdependencies and progressing issues toward resolution.

• Act as the main operational liaison for Business Development partners, coordinating payer requirements, claims, rosters, complaints, and escalation matters.

• Collaborate with the Business Development Team during payer discussions to advance RCM topics, align stakeholders, and resolve issues.

• Stay informed about new payer requirements and evolving mergers, proactively mobilizing internal teams to implement necessary changes.

• Track and report RCM performance by payer, identifying trends and risks, and engaging teams to drive enhancements.

• Deliver improvements in RCM performance for the portfolio, achieve payer performance targets, execute timely payer initiatives, maintain payer health assessments/business reviews, and ensure stakeholder satisfaction.

⛳️ Requirements

• Proven experience in healthcare operations with a solid understanding of insurance claims and payer relationships.

• Excellent cross-functional collaboration abilities, with a knack for aligning teams without direct authority.

• Demonstrated success in managing complex projects with multiple stakeholders from initiation to launch.

• Comfort in navigating ambiguity while proactively identifying subsequent steps.

• Exceptional communication skills for simplifying operational complexities to both internal partners and external payer contacts.

• Detail-oriented and data-driven mindset, capable of monitoring performance metrics and translating them into actionable insights.

🏝️ Benefits

• We’re a remote-first organization.

• Health insurance plans offered through Aetna (medical and dental) and MetLife (vision), including FSA and HSA options.

• 401K plan managed by ADP.

• Lifestyle Spending Account for health, wellness, and family care expenses.

• Monthly stipend for co-working space memberships.

• Monthly work-from-home allowance.

• Financial wellness benefits available through Northstar.

• Discount program for pets through United Pet Care.

• Financial perks and rewards provided via PerkSpot.

• Employee Assistance Program (EAP) access through Aetna.

• One-time stipend for setting up your home office.

• Inclusive family and medical leave policies.

• 12 paid holidays along with 1 Alma Give Back Day.

• Flexible paid time off (PTO).