Senior Specialist - Payer Operations

The Payer Operations Specialist will report to the Senior Program Manager of Payer Operations. This role involves developing an expert-level understanding of our Payer partners’ billing, payment, and cross-functional operations and compliance requirements. The primary responsibilities will be to support new payer launches, expand existing payer customer businesses, and monitor ongoing payer operation processes. To achieve this, the Payer Operations Specialist will collaborate with a wide range of stakeholders to quickly learn and navigate business, legal, analytical, product, and operational requirements. This is a full-time remote position with occasional travel for team meetings. 

Ideal Candidate:

We are seeking a candidate with experience as an analyst in the finance or healthcare sector seeking a transition into a strategic operational role.

What you’ll be doing: 

• Data Analytics
• Analyze clinical, operational, and financial data to monitor payer operations' health and performance.
• Identify root causes of clinical, operational, and financial issues and risks.
• Provide visibility into strategic opportunities for payer operations.
• Monitor and report on process performance, quantifying efficiency gains and identifying areas for further improvement.
• Project Management & Implementation
• Identify implementation requirements, risks, and milestones
• Ensure project deliverables remain on track; escalate, and identify potential risks 
• Keep internal and external business stakeholders informed and engaged
• Define clear project deliverables and criteria for success to meet project launch timelines
• Documentation
• Document Payer Operations requirements, workflows, and SOP to ensure clarity, consistency, and regulatory compliance
• Develop and maintain a robust internal knowledge base for Payer Operations and cross-functional partners, proactively updating documentation as needed
• Coordinate with cross functional leaders to review documentation and align workflows

What success looks like in this role:

• Managing tasks leveraging data analytics, projectment management, and documentation skill sets to ensure our health plan DSO metrics are optimal
• Managing tasks leveraging data analytics, projectment management, and documentation skill sets to remove any barriers to care to maximize the total number of therapy appointments completed by health plan members

What we expect from you: 

• Bachelor's degree in Business, Finance, Healthcare Administration, Operations Management, or related field
• 3+ years of experience in process engineering, analytics, and healthcare operations 
• Strong understanding of industry standards and regulatory requirements
• Excellent project management and problem-solving skills
• Exceptional technical writing skill with the ability to translate complex information to concise, easy-to-reference resources
• Strong communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Resilience and a solution-focused mindset to thrive autonomously in constantly changing and ambiguous hyper-growth environments

Preferred Skill Sets and Experiences (Desired but not required):

• PMP or CAPM certification 
• Experience using SQL, Snowflake, and Looker
• Experience with analytics, data modeling, and architecture
• Experience with financial modeling
• Knowledge of healthcare data standards (X12 837, 276/277, 835, 270/271, etc.)
• Experience with process improvement, including Lean Six Sigma methodologies
• Experience working with or for a health plan

The target base salary range for this position is $75,000 - $95,000, and is part of a competitive total rewards package including stock options and benefits. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually using Radford Global Compensation Database at minimum to ensure competitive and fair pay. 

Benefits provided by Spring Health:

Note: We have even more benefits than listed here and below, your recruiter will provide more in-depth information as you continue in the interview process. Benefits are subject to individual plan requirements and eligibility criteria.

• Health, Dental, Vision benefits start on your first day at Spring. You and your dependents also receive access to One Medical accounts HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type.
• Employer sponsored 401(k) match of up to 2% for retirement planning
• A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents.
• We offer competitive paid time off policies including vacation, sick leave and company holidays.
• At 6 months tenure with Spring, we offer parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents.
• Access to Noom, a weight management program—based in psychology, that’s tailored to your unique needs and goals. 
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses.
• Access to Wellhub,  which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription
• Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care
• Up to $1,000 Professional Development Reimbursement a year.
• $200 per year donation matching to support your favorite causes.