Director of Payor Operations
Equip
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $148,000 - $185,000 per year
Job Level
About the role
- Partner with cross functional leaders to ensure internal processes and care delivery are in accordance with health plan needs across commercial and Medicaid lines of business.
- Translate health plan contracts, provider manuals, and regulatory requirements into scalable operational workflows.
- Serve as the internal subject-matter expert on credentialing and payor operational requirements.
- Oversee the Credentialing team to ensure providers are enrolled, credentialed, and re-credentialed across all contracted payors, including Medicaid, in a timely and compliant manner.
- Partner cross-functionally with various teams including Care Delivery, Care Operations, Payor Partnerships, Revenue Cycle, and Legal to ensure operational readiness and alignment with existing payor contract obligations, current and new regulatory requirements, and new payor implementations and market expansion.
- Provide operational insight and data to support payor performance discussions and contract optimization.
- Establish KPIs and develop reporting mechanisms to track performance for credentialing and overall payor operations.
- Identify operational risks and process inefficiencies and lead remediation efforts as needed.
- Support payor audits, payor reviews, and regulatory or compliance inquiries as needed.
- Perform other duties as assigned.
Requirements
- 8+ years of experience in payor operations, managed care operations, or healthcare administration.
- Demonstrated experience and expertise with commercial health plans and Medicaid, including regulatory and compliance requirements.
- Proven leadership experience managing operational teams in a fast-paced environment.
- Strong cross-functional collaborator who can partner effectively with clinical and operational stakeholders.
- Experience in healthcare startups or high-growth environments strongly preferred.
- Ability to translate complex contracts and regulations into clear, executable workflows.
Benefits
- Flex PTO policy (3-5 wks/year recommended) + 11 paid company holidays.
- Generous parental leave.
- Competitive Medical, Dental, Vision, Life, and AD&D insurance.
- Equip pays for a significant percentage of benefits premiums for individuals and families.
- Spring Health, a 100% employer-paid mental health benefit through Guardian.
- You can receive 5 free therapy sessions and 5 free coaching sessions per year for you and each of your dependents.
- Employee Assistance Program (EAP), a company paid resource for mental health, legal services, financial support, and more!
- HealthJoy, a 100% employer-paid platform connecting you to a healthcare concierge who can help you navigate your benefits.
- 401K Option!
- $50/month stipend added directly to an employee’s paycheck to cover home internet expenses.
- $250/month stipend to use a co-working space.
- Initial work-from-home stipend of up to $500.
- Reload of $200 on the home office stipend at the 3-year mark and then every other year after that (year 5, year 7, etc.).
- Company Laptop.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
payor operationsmanaged care operationshealthcare administrationcredentialingregulatory complianceoperational workflowsKPI developmentdata reportingcontract optimizationrisk identification
Soft Skills
leadershipcross-functional collaborationcommunicationoperational insightproblem-solvingstakeholder engagementteam managementprocess improvementadaptabilitystrategic thinking