Senior Specialist, Payer Operations

The 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 Specialist will collaborate with a wide range of stakeholders to quickly learn and navigate business, legal, analytical, product, and operational requirements. 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: 

• 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 at minimum to ensure competitive and fair pay.

Don’t meet every requirement? Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At Spring Health we are dedicated to building a diverse, inclusive and authentic workplace

To ensure intentional and equitable hiring practices, we use a balanced candidate slate in our interviews. This approach guarantees that our pool of qualified candidates includes individuals who are underrepresented in our organization at all levels. This is a key performance indicator (KPI) for our recruiting and hiring teams, reported quarterly to maintain accountability.

Please note: You must wait 60 days before re-applying for the same job. Additionally, you can apply to up to three jobs within a rolling 30 day window. Focus on applying to jobs that are the most suitable match for your talents by carefully reading the overview and qualification information.

Ready to do the most impactful work of your life? Learn more about our values, how we work, and how hypergrowth meets impact at Spring Health: Our Values

Hypergrowth meets impact

What to expect working here:

• You will be held accountable to an exceptionally high bar and impact
• This may be the fastest work environment you will ever experience in terms of growth, decision-making, and time to impact
• You will be empowered to set your own boundaries and asked to adapt them in critical moments when the company needs you
• You will create processes & products that have never existed before
• You will have very direct conversations and receive continuous feedback to push you to become the most thriving team member and performer you can be
• Change is a constant here: your role, team, responsibilities, and success metrics will shift as the company grows

And…

• You get to be surrounded by some of the brightest minds in the field  
• You get to learn and grow at an extremely accelerated pace
• You will experience transparency, integrity, &  humility from leadership 
• You will be empowered to constantly challenge the status quo
• You get the space to experiment & innovate
• You get to make a transformational impact for the company, mental health, and for real human lives — and you will see that impact quickly
• You will become more resourceful and resilient
• You get to be part of a winning team that opens doors in the future

Benefits provided by Spring Health:

Your Total Health:

• Health, Dental, Vision benefits start on your first day at Spring Health. You and your dependents also receive an individual One Medical account which is valued at $199/year per user. HSA and FSA plans available
• A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents
• 10 allocated sick days per year
• Flexible paid time off in addition to 12 paid holidays throughout the year
• Access to Gympass, an on-demand virtual benefit that provides wellbeing coaching, and budget management.
• Spring Renewal: When you hit your four-year Springaversary, you’ll be awarded a four week, fully paid, sabbatical leave to renew and recharge. 

You And Your family:

• 4-4.5 months of fully paid parental leave
• Spring Health provides team members and their families with sponsored access to Bright Horizons® child care, back-up care, and elder care.
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses

Supporting you financially through:

• Our People team benchmarks all salaries using the Radford Global Compensation Database for technology and life sciences industries. Radford benchmarks salaries with 3,589 global firms, 6.5 million employees, and 98 countries across the globe. We do this to ensure all of our team members are paid equally and competitively.
• On top of competitive and benchmarked salary, Spring Health offers incentive pay (based on role), and equity that begins vesting as we celebrate your first year with the company!
• Employer sponsored 401(k) match of up to 2% after 90 days of employment

Creating a culture you can thrive in:

• Flexible work arrangements: 66% of Spring Health team members work fully remote while 33% work in a hybrid model from our New York City offices
• Focus Fridays: no meetings, no distractions, just time for you to get work done.
• Focus Weeks: In Spring 2023, we held our first ever Focus Week, we canceled all non-essential meetings, minimized distractions, and you, our team members, to dive into the key work that gets chopped up or deprioritized during the regular day-to-day. We saw a 36% jump in the average energized score after those five days of flow state work and are finalizing a plan for quarterly Focus Weeks for team members.
• Up to $1,000 Professional Development Reimbursement per calendar year.
• $200 per year donation matching to support your favorite causes

Our privacy policy: https://springhealth.com/privacy-policy/

Don’t meet every requirement? Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At Spring Health we are dedicated to building a diverse, inclusive and authentic workplace

To ensure intentional and equitable hiring practices, we use a balanced candidate slate in our interviews. This approach guarantees that our pool of qualified candidates includes individuals who are underrepresented in our organization at all levels. This is a key performance indicator (KPI) for our recruiting and hiring teams, reported quarterly to maintain accountability.