Senior Manager, Payor Intelligence

As the Sr Manager of Payor Intelligence, reporting to the Sr Director of Revenue Cycle, your leadership will drive strategic decision making and operational excellence within the Revenue Cycle department. You will take a lead in optimizing Included Health’s billing and enrollment teams consisting of 8 members and play a crucial role in our RCM transformation into a dynamic, data driven, strategic team.

• Prompt and regular attendance at assigned work location.
• Ability to remain seated in a stationary position for prolonged periods.
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
• Ability to interact with leadership, employees, and members in an appropriate manner.

• Team Leadership:
• Lead and manage a team of enrollment and payor intelligence representatives, fostering collaboration, growth, and performance.
• Identify KPIs to analyze and monitor data to measure productivity, staffing models, and potential operational improvement initiatives.
• Payor Relationship Management:
• Develop and maintain strong relationships with payors and Client Services assisting in the negotiating contracts, resolving issues, and ensuring timely reimbursements.
• Own payor contract documentation and requirements across Billing and Enrollment.
• Align business approach of payor contracts and trends to core operations of process integrity, identifying inefficiencies, waste, manual effort, and opportunities for scalable improvement.
• Enrollment Strategy:
• Ownership and oversight of the provider enrollment systems (athenahealth and credential stream) and worklists.
• Oversee enrollment processes including streamline workflows, and enhance efficiency to maximize enrollment.
• Data Insights:
• Leverage data analytics to identify trends, opportunities, and areas for improvement within payor networks.
• Create actionable plans.
• Cross-Functional Collaboration:
• Collaborate with other departments (such as finance, legal, and operations) to align strategies and achieve organizational goals.
• Collaborate with functional management teams and key business stakeholders to design, develop, and implement strategies for optimizing business processes and workflows.
• Innovation:
• Drive innovation by exploring new technologies, process improvements, and best practices in payor relations and enrollment.
• Continue to foster a culture of innovative thinking and continuous improvement through education and coaching.

• 15 or more years of experience in managing teams including but not limited to staff development, designing and driving productivity, and creating career paths
• 10 or more years of experience in payor contracts and reimbursement methodologies, payor operations, and claims processing
• 10 or more years of experience in provider enrollment with both Government and Commercial payors with a strong preference for someone who has led a strategic redesign or new build of this function
• Strong organizational skills to develop an easily searchable and sustainable repository of detailed payor intelligence and data
• Creativity and deductive reasoning skills to triangulate root causes of claim issues
• Outstanding documentation and communication skills to relay detailed technical information in a succinct, actionable manner

• athena experience strongly preferred including management of the athena enrollment tables
• Experience working with product teams to design and implement new features supporting the billing and enrollment functions

The United States new hire base salary target ranges for this full-time position are:

Zone A: $128,130 - $180,990 + equity + benefits  

Zone B: $147,350 - $208,139 + equity + benefits  

Zone C: $160,163 - $226,238 + equity + benefits  

Zone D: $166,569 - $235,287 + equity + benefits  

This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and competitive compensation based on their roles and locations. Your Recruiter can share details of your geographic alignment upon inquiry.

In addition to earning a base salary, this role is eligible for a performance-based bonus. Details of the Annual Bonus Plan, including performance metrics, target incentives, and potential earnings, will be discussed during the interview process.

Benefits & Perks:

In addition to receiving a competitive pay,  the compensation package may include, depending on the role, the following: 

Remote-first culture

401(k) savings plan through FidelityComprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents 

Generous Paid Time Off ("PTO") and Discretionary Time Off (“DTO")

12 weeks of 100% Paid Parental leave

Up to $25,000 Fertility and Family Building Benefit Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment) 

11 Holidays Paid with one Floating Paid Holiday

Work-From-Home reimbursement to support team collaboration and effective home office work 

24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

Your recruiter will share more about the benefits package for your role during the hiring process.

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.