Strategic Payer Partner Lead

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

📋 Description

• Provide oversight, mentorship, and performance auditing for the Strategic Payor Partner team.

• Manage and oversee regional payer assignments effectively.

• Act as a primary resource for regionally assigned SPPs and address complex payer issues.

• Review escalations, including identifying sources from the field versus payer.

• Conduct audits on root cause findings and ensure uniformity in resolution documentation.

• Monitor payer performance trends across assigned regions to pinpoint systemic gaps.

• Collaborate with Market Access, DMAs, and RCM liaisons to create coordinated multi-team response plans.

• Assist leadership with KPI dashboards, summaries of payer performance, and compliance reporting.

• Aid in the development of SOPs, standard templates, and escalation workflows.

• Mentor newer SPPs and support onboarding and role-specific development.

• Communicate results to RCM managers and/or billing vendors.

• Track the execution and follow-through of payer remediation efforts.

• Contribute to recommendations for process improvement and automation.

• Develop and manage team scorecards and process quality standards.

• Perform additional tasks that support departmental objectives and enhance operational efficiency.

⛳️ Requirements

• Minimum of 7 years' experience in healthcare revenue cycle or payer performance roles.

• Capability to interpret data trends, model performance, and pinpoint actionable insights.

• Excellent communication skills with the ability to navigate cross-functional teams effectively.

• Proficiency in Excel and data visualization tools.

• Knowledgeable in denial management, EOB interpretation, and AR/cash collection strategies.

• Experience working within a matrixed environment alongside cross-functional teams.

• Background in supporting or leading a payer-focused team.

• Strong analytical, communication, and collaboration abilities.

• Comfortable reviewing dashboards, audit trails, and payer trend data.

• Skilled in advanced root cause analysis and data interpretation.

• Strong grasp of payer behavior, reimbursement trends, and post-claim RCM workflows.

• Experience in leading or mentoring revenue cycle or payer-focused teams.

• Exceptional communication and stakeholder engagement skills.

• Proficient in achieving cross-functional alignment and resolving escalations.

• Familiar with AR management processes and coordinating with billing vendors.

• High attention to detail with a disciplined approach to documentation and audit trails.

• Proficient in Excel and utilizing payer performance dashboards (e.g., Power BI, Tableau).

• Ability to coach team members and support training initiatives.

• Organized, proactive, and results-driven with strong follow-through skills.

• Bachelor’s Degree in Healthcare Administration, Business, or a related field.

• Willingness to travel up to 25%.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Paid holidays.

• Paid time off.

• 401K with company match.

• Employee Stock Purchase Plan.

• Annual organizational/cultural committee events.

• Reasonable accommodations for qualified individuals with disabilities.