Payer Workflow & Integration Lead

Posted 2 Days Ago
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Hiring Remotely in USA
Remote
111K-155K Annually
Senior level
Artificial Intelligence • Software
The Role
The Payer Workflow & Integration Lead advises on payer workflows, guides integration designs, identifies risks, and enhances implementation quality in healthcare settings.
Summary Generated by Built In

At MCG, we lead the healthcare community to deliver patient-focused care. We have a mission-driven team of talented physicians and technical experts developing our evidence-based content and innovating our products to accelerate improvements in healthcare. If you are driven to enhance the US healthcare system, MCG is eager to have you join our team. We cultivate a work environment that nurtures personal and professional growth, and this is a thrilling time to become a part of our organization. With dynamic roles that offer meaningful impact, you'll be able to fully realize your potential. Plus, you'll enjoy world-class benefits and the security, stability, and resources of our parent company, Hearst, with over 100 years of experience.

The Payer Workflow & Integration Lead serves as a subject matter expert in payer-side healthcare workflows, system integrations, and data flows, supporting customer implementations through advisory guidance rather than execution. This role partners closely with Implementation, Product, and technical teams to identify risks early, answer complex workflow and integration questions, and guide solution design within real-world payer environments.

By bringing deep expertise in health plan operations and system interactions, this individual helps teams anticipate challenges, reduce implementation delays, and improve overall delivery quality. This role is critical in strengthening internal capability, reducing reliance on limited subject matter experts, and increasing customer confidence in how solutions function within their organizations.

You Will:

 Serve as a subject matter expert on payer workflows, system integrations, and data flows
 Advise implementation teams and customers on how solutions will function within complex payer environments
 Lead or support workflow discovery and provide guidance on integration design during customer implementations
 Identify risks, gaps, and potential blockers early in the implementation lifecycle and recommend solutions
 Act as an escalation point for complex workflow and integration-related questions and challenges
 Translate complex technical and operational concepts into clear, actionable guidance for internal teams and customers
 Partner cross-functionally with Product, Implementation, and technical teams to align on solution design and execution
 Support customer-facing discussions related to workflow, integrations, and how solutions operate within their environments
 Reduce dependency on Product teams by providing real-time workflow and integration expertise during implementations
 Analyze patterns across implementations to identify recurring issues and recommend systemic improvements
 Proactively assess customer environments to identify potential workflow and integration challenges prior to and during implementation
 Provide guidance on how payer-specific processes (e.g., utilization management, prior authorization) may impact solution design and configuration
 Facilitate working sessions with internal teams and customers to clarify workflows, integration points, and data dependencies
 Advise on trade-offs and alternative approaches when standard implementation paths do not align with customer environments
 Develop and maintain reusable artifacts (e.g., workflow diagrams, integration patterns, decision frameworks) to support consistent implementation outcomes
 Contribute to standardizing implementation approaches, best practices, and processes to improve efficiency and scalability
 Develop training materials and support cross-team enablement to expand workflow and integration knowledge
 Mentor and upskill implementation team members on payer workflows, integration concepts, and issue identification
 Provide field-driven feedback to Product teams on workflow gaps, integration challenges, and opportunities for enhancement
 Support pre-implementation or late-stage sales conversations as a subject matter expert to validate feasibility and set expectations
 Evaluate and recommend improvements to implementation processes to reduce cycle time and increase predictability
 Support resolution of complex integration and workflow-related challenges across customer engagements

What We're Looking For:

 Bachelor’s degree in Healthcare Administration, Information Systems, Computer Science, Business, or a related field, or equivalent combination of education and experience
 At least 5 years of experience working with health plan (payer) systems, workflows, and operations
 Hands-on experience supporting or advising on healthcare implementations, system integrations, or workflow design within payer environments
 Strong understanding of end-to-end healthcare workflows, particularly within payer settings
 Demonstrated experience with system integrations and data flows across multiple platforms (e.g., APIs, HL7/FHIR, or similar standards)
 Proven ability to analyze, interpret, and translate business and technical requirements into actionable guidance
 Experience working cross-functionally with technical, operational, and business stakeholders
 Ability to diagnose complex workflow and integration issues and recommend effective solutions.
 Strong communication skills, with the ability to engage effectively with both technical and non-technical audiences

Preferred Qualifications:

 Knowledge of HL7 Da Vinci implementation guides, particularly related to Prior Authorization
 Knowledge of Utilization Management and/or Prior Authorization processes
 Strong communication skills, with the ability to engage effectively with both technical and non-technical audiences
 Strong written and verbal communication skills
 Strong problem-solving skills and ability to think beyond standard solutions
 Ability to collaborate across teams and influence without direct authority

Pay Range: $111,000 - $155,400

Other compensation: Bonus Eligible

Perks & Benefits:  

💻 Remote work

✈️ Travel expected 3-4 times per year for company-sponsored events 

🩺 Medical, dental, vision, life, and disability insurance 

📈 401K retirement plan; flexible spending and health savings account 

🏝️ 15 days of paid time off + additional front-loaded personal days 

🏖️ 14 company-recognized holidays + paid volunteer days  

👶 up to 8 weeks of paid parental leave + 10 weeks of paid bonding leave  

🌈 LGBTQ+ Health Services 

🐶 Pet insurance  

📣 Check out more of our benefits here: https://www.mcg.com/about/careers/benefits/  

Remote with Occasional Travel (1–3 trips per year) 

MCG Health is a Seattle, Washington-based company and is considering remote candidates with some travel for company-sponsored events.  

The ideal candidate should be comfortable balancing the independence of remote work with the collaborative opportunities offered by periodic in-person engagements. 

We embrace diversity and equal opportunity and are committed to building a team that represents a variety of backgrounds, perspectives, and skills. Only with diverse thoughts and ideas will we be able to create the change we want in healthcare. The more inclusive we are, the better our work will be for it.  

 
 

All roles at MCG are expected to engage in occasional travel to participate in team or company-sponsored events for the purposes of connection and collaboration. 

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

MCG is a leading healthcare organization dedicated to patient-focused care. We value our employees' unique differences and are an Equal Employment Opportunity (EEO) employer. Our diverse workforce helps us achieve our goal of providing the right care to everyone. We welcome all qualified applicants without regard to race, religion, nationality, gender, sexual orientation, gender identity, age, marital status, veteran status, disability, pregnancy, parental status, genetic information, or political affiliation. We are committed to improving equity in healthcare and believe that a diverse workplace fosters curiosity, innovation, and business success. We are happy to provide accommodations for individuals. Please let us know if you require any support.

Top Skills

APIs
Fhir
Hl7
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The Company
HQ: Seattle, WA
482 Employees
Year Founded: 1988

What We Do

MCG, part of the Hearst Health network, helps healthcare organizations implement informed care strategies that proactively and efficiently move patients toward health. MCG’s independent and transparent review of clinical evidence gives healthcare organizations confidence in their patient-centered care. By leveraging artificial intelligence and other technology, MCG presents this information within the workflow, to simplify and prioritize the work. MCG’s world-class customer service team ensures that clients are able to maximize the benefits of ownership for both content and software – demonstrating a return on financial investment as well as patient outcomes. Our solutions are used by several U.S. government agencies, a majority of U.S. health plans, and nearly 2,600 hospitals.

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