Manager, Payer Operations
Aledade, Inc.
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
About the role
- Establish and monitor performance metrics (KPIs) to measure the reliability, latency, and saturation of payer data feeds.
- Define and refine standard operating procedures (SOPs) for data issue triage, clinical ingestion troubleshooting, and Primary Source Verification (PSV) audits.
- Lead discovery efforts for long-term data operations and technical requirements to transition from reactive troubleshooting to proactive monitoring.
- Serve as the primary point of escalation for high-priority payer data issues, coordinating closely with Payer Strategy & Engagement (PSE), Health Plan Partnerships (HPP), Product, and Technology teams.
- Partner with Product teams to identify systemic data ingestion failures and influence the product roadmap for automated monitoring solutions.
- Support the Care Gap operations team by overseeing investigations into manual upload failures and measure mapping exercises.
- Oversee the documentation and submission processes for HEDIS and other clinical data extracts to ensure audit readiness.
- Ensure all team activities comply with healthcare regulations and data security standards.
- Other duties as assigned.
Requirements
- Bachelor’s degree in Healthcare Administration, Data Analytics, Information Systems, or a related field, or equivalent experience.
- 5+ years of experience in healthcare data operations, payer relations, or health informatics, with at least 2-4 years in a leadership or supervisory capacity.
- Advanced proficiency in SQL for data investigation and root cause analysis; familiarity with data observability tools (e.g. Tableau) and SFTP protocols.
- Deep understanding of payer data structures (claims, clinical feeds, care gaps) and healthcare quality reporting (HEDIS, MA Stars).
- Proven ability to lead teams through complex technical troubleshooting and manage high-volume issue queues (e.g., Jira-based workflows).
- Exceptional verbal and written communication skills, with a demonstrated ability to influence decision-makers and manage external payer relationships effectively.
- Ability to translate complex data issues into actionable business insights and operational improvements.
Benefits
- Flexible work schedules and the ability to work remotely are available for many roles
- Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
- Robust time-off plan (21 days of PTO in your first year)
- Two paid volunteer days and 11 paid holidays
- 12 weeks paid parental leave for all new parents
- Six weeks paid sabbatical after six years of service
- Educational Assistant Program and Clinical Employee Reimbursement Program
- 401(k) with up to 4% match
- Stock options
- And much more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
SQLdata investigationroot cause analysisdata observabilitydata ingestiondata issue triageclinical ingestion troubleshootingPrimary Source VerificationHEDIShealthcare quality reporting
Soft Skills
leadershipcommunicationinfluencingproblem-solvingteam managementoperational improvementdecision-makingcollaborationdocumentationaudit readiness