Manager, Payer Contracting

The role

The Manager, Payer Contracting will own the strategy, negotiation, and ongoing management of the payer contracting portfolio. This person will assess existing contracts, lead negotiations with national and regional payers, and partner with internal teams to ensure successful implementation.

What you will do

• Own the payer contracting portfolio including identification, negotiation, implementation, and renewal.
• Build a comprehensive inventory and contracting map across OpenLoop entities.
• Determine appropriate contracting strategy across group-level and individual provider contracts.
• Lead payer negotiations and renegotiations as the primary representative.
• Negotiate reimbursement rates, fee schedules, and contract terms.
• Use financial and reimbursement data to develop negotiation strategies.
• Partner with Revenue Cycle Management and coding stakeholders to understand billing implications.
• Collaborate with Payer Enrollment to align contracted entities and providers with agreements.
• Coordinate with internal stakeholders to ensure contracts are implemented into downstream systems.
• Evaluate existing contracts to identify opportunities to consolidate or restructure.

Required qualifications

• Bachelor’s degree or equivalent relevant experience.
• 6+ years of progressive experience in payer, managed care, or provider contracting.
• Significant experience negotiating payer contracts from the provider side.
• Demonstrated experience managing contracts across multiple payers, entities, markets, or states.
• Strong understanding of group versus individual provider contracting.
• Deep understanding of healthcare reimbursement methodologies, provider contracting, fee schedules, claims reimbursement, and managed care contracting.
• Experience evaluating financial and operational data to prepare for payer negotiations.
• Working knowledge of Medicare, Medicaid, Medicaid Managed Care Organizations, Medicare Advantage, and commercial payer contracting.
• Experience partnering with Revenue Cycle Management, Payer Enrollment, Finance, Coding, Clinical Operations, and other stakeholders.
• Ability to independently bring structure to incomplete or fragmented information.
• Ability to manage multiple complex priorities and sensitive deadlines with a high degree of autonomy.

Nice to have

• Experience working within both a payer and provider organization.
• Experience leading payer contracting for a national healthcare, telehealth, physician group, hospital, or other multi-state provider organization.
• Experience with value-based contracting or alternative reimbursement arrangements.
• Experience consolidating or restructuring payer agreements following acquisitions, entity changes, or organizational growth.
• Familiarity with provider enrollment and credentialing platforms such as MDStaff, Medallion, or Verisys.
• Familiarity with payer portals, healthcare billing systems, contract management tools, and workflow platforms such as Jira, Zendesk, or Zoho Desk.

Benefits

• Competitive compensation
• Medical, Dental & Vision
• Flexible Spending / Health Savings Accounts
• Generous PTO and company holidays
• 401(k)
• Additional benefits and programs based on eligibility

About the company

OpenLoop provides telehealth support solutions designed to streamline care delivery for companies offering virtual support across all 50 states. The company has a relatively flat organizational structure with core values of Autonomy, Competence and Belonging.