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Aledade is the largest network of independent primary care.
The Role
The Manager of Payer Operations oversees payer data integrations, transforming data into actionable insights while leading cross-functional teams and ensuring compliance with healthcare regulations.
Summary Generated by Built In
The Manager, Payer Operations serves as the strategic leader overseeing the complex ecosystem of 130+ unique payer data integrations that directly impact patient care and practice success. In this critical role, you'll transform raw healthcare data into actionable insights while leading cross-functional teams through sophisticated technical challenges and serving as the trusted escalation point for high-priority data issues. You'll collaborate closely with Product, Technology, and Payer Strategy teams to influence the future of our data operations, moving from reactive troubleshooting to predictive, automated monitoring systems while ensuring compliance with healthcare regulations and maintaining the data integrity that enables providers to deliver exceptional patient care. This position combines strategic thinking with hands-on problem-solving, requiring you to translate complex technical data challenges into business solutions that keep our healthcare partners running smoothly and focused on what matters most: caring for patients.
Candidates should be comfortable working remotely/work from home anywhere within the US.
Operational Strategy & Oversight
- 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.
Cross-Functional Collaboration
- 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.
Compliance & Quality Assurance
- 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.
Minimum Qualifications:
- 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.
Preferred Qualifications:
- Master’s degree in Healthcare Administration, Business Administration, Data Analytics, Information Systems, or a related field, or equivalent experience.
- Experience in value based care
- Experience promoting or selling to physicians, physician practices or related associations
- Experience leading cross-functionally within a complex organization
- Proactive self-starter with the ability to lead in a fast-paced environment, with the ability to work independently, as part of a team, and as a leader
Who We Are:
Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
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!
At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
Privacy Policy: By applying for this job, you agree to Aledade's Applicant Privacy Policy available at https://www.aledade.com/privacy-policy-applicants
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The Company
What We Do
Aledade is the largest network of independent primary care, enabling clinicians to deliver better patient outcomes and generate more savings revenue through value-based care. Aledade’s data, personal coaching, user-friendly workflows, health care policy expertise, strong payer relationships and integrated care solutions enable primary care organizations to succeed financially by keeping people healthy. Together with more than 1,900 practices and community health centers in 45 states and the District of Columbia, Aledade manages accountable care organizations that share in the risk and reward across more than 200 value-based contracts representing more than 2.5 million patient lives. To learn more, visit www.aledade.com or follow on X (Twitter), Facebook or LinkedIn.
Why Work With Us
At Aledade, we’re all about doing good for patients, practices and society - which is why we’re so passionate about value-based care and the work we do every day. Because we’re working to benefit all of society, we believe the best way to do so is to utilize all of our team members and their unique experiences, interests, backgrounds and beliefs.
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