Apply on Employer Site

Evergreen Nephrology · 1 day ago

Director, Payer Operations

United States

Full-time

Remote

Director/Executive

$160K/yr - $180K/yr

10+ years exp

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based approach. The Director, Payer Operations is responsible for leading business processes to enhance efficiency in managing health plan contracts, including operational optimization and cross-functional collaboration.

Health CareMedicalWellness

Responsibilities

Lead complex operational initiatives including practice rostering and policy development

Manage a cross-functional team overseeing contract lifecycle management in collaboration with Strategic Payer Partnerships, Legal, Product, and other departments

Drive operational excellence, team productivity, and a strong team culture

Establish and enforce reliable processes across all stages of contract participation (eligibility, roster submission, reconciliation, withdrawal)

Improve workflows for both existing and new contract flows

Implement audit reporting and error-intake processes to proactively detect and resolve discrepancies

Lead, organize and implement monthly and quarterly joint payer meetings

Partner with internal teams to build systems and tools for accurate roster management

Represent business users in product design and development

Coordinate with teams to ensure data accuracy and alignment with practice rosters

Other duties consistent with this role, as assigned

Qualification

Healthcare operationsPayer contractingContract management systemsStakeholder engagementAnalytical abilitiesLeadership skillsOrganizational abilitiesMS Office SuiteValue-based contractsCommunication skills

Required

Bachelor's degree in healthcare or related field

10+ years of experience in healthcare operations, including payer contracting or provider credentialing

6–8 years of management experience

Strong leadership and stakeholder engagement skills

Excellent organizational and analytical abilities

Proficiency in contract management systems (CRM)

Strong verbal, written, and presentation communication skills

Intermediate skills with MS Office Suite of products including Outlook and Teams

Able to work effectively in a primarily remote environment: Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended. Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role. Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information