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Payers Direct Jobs in Virginia (NOW HIRING)

Revive Bhs Llc

Executive Director

Richmond, VA · On-site

$80K - $120K/yr

Position Summary The Executive Director provides strategic, operational, financial, and regulatory ... Community Payer Relations ● Maintain relationships with Virginia Medicaid MCO representatives ...

Revive Bhs Llc

Executive Director

Richmond, VA · On-site

$80K - $120K/yr

Position Summary The Executive Director provides strategic, operational, financial, and regulatory ... Community Payer Relations ● Maintain relationships with Virginia Medicaid MCO representatives ...

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Payers Direct information

What is the difference between Payers Direct vs Payers Account Manager?

AspectPayers DirectPayers Account Manager
CredentialsTypically requires insurance or healthcare-related certifications, such as CPC or CPC-HOften requires similar certifications, with additional experience in client management
Work EnvironmentPrimarily office-based, handling claims processing and payer communicationsOffice setting with client interaction, focusing on account management and relationship building
Employer & IndustryHealth insurance companies, healthcare providers

While both roles involve working with payers in the healthcare industry, Payers Direct focuses on claims processing and payer communication, whereas Payers Account Managers emphasize maintaining client relationships and account oversight. Understanding these differences helps in choosing the right career path or job search focus within healthcare insurance roles.

What are popular job titles related to Payers Direct jobs in Virginia? For Payers Direct jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Payers Direct jobs in Virginia look for? The top searched job categories for Payers Direct jobs in Virginia are:
What cities in Virginia are hiring for Payers Direct jobs? Cities in Virginia with the most Payers Direct job openings:
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Director, Payer Contracting (MA & Medicaid)

Director, Payer Contracting (MA & Medicaid)

Aledade

Arlington, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

Aledade rating

8.6

Company rating: 8.6 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

46th of 451 rated business services

Job description

The Director, Payer Contracting, MA & Medicaid on the Strategic Payer Partnerships team will execute Aledade's Medicare Advantage and Medicaid value-based care contracts with national and regional health plans as we help primary care providers shift into value-based care. The role will be focused on negotiating value-based care contracts with health plans for their Medicare Advantage and Medicaid members. This role will report to the VP, MA & Medicaid Contracting.
 
We are flexible with respect to geographic location, and the ideal candidate will be comfortable working remotely/work from home within the US or be based from Bethesda, MD office.
 
Primary Duties:
Negotiation & Strategy:
  • Negotiate and renegotiate MA & Medicaid value-based care contracts with prospective payer partners
  • Proactively engage with payer partners to set and/or improve contract terms
  • Collaborate with Senior Leadership to qualify and source market growth and expansion for multi-year risk arrangements
Contract Management & Reporting:
  • Communicate with key, internal stakeholders to ensure a smooth and timely implementation of negotiated terms
  • Read, draft contract language, and track deliverables to ensure compliance and consistency; Compile data and report updates
  • Develop and maintain a deep knowledge of existing MA & Medicaid contract terms and act as the internal expert for contract questions
Relationship Management:
  • Build and manage relationships with payers and other key stakeholders to resolve issues, optimize performance, and identify new opportunities for collaboration.
Other duties as assigned
Minimum Qualifications:
  • Bachelor's degree
  • 12+ years in healthcare with health plans or provider groups working on contract negotiations within value-based care
  • Results-oriented with the ability to exercise influence to achieve goals rather than control
  • Proven track record of creating, maintaining, and enhancing relationships and communicating effectively with senior management
  • Exceptional attention to detail in contractual language and processes
  • Expert sales, business development, growth professional at local and national level
  • Passionate about driving the shift from fee-for-service to value based care
Preferred Qualifications:
  • Master's degree or other advanced degrees in management, health services research, health and/or public policy, or other relevant fields 
Physical Requirements:
  • Prolonged periods of sitting at a desk and working on a computer.
#LI-KC1

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
We may use automated tools, including artificial intelligence (AI), to help organize and evaluate application materials. These tools support our recruiters and hiring managers by helping manage large applicant pools. Human judgment plays an essential role in our hiring process, including in the oversight and use of any automated tools. If you would like more information about our screening and hiring process, please contact us.
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What Aledade employees say

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About Aledade

Sourced by ZipRecruiter

Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. We are on a mission to change healthcare for the better and solve complex problems within the healthcare system. We follow the simple but radical idea that Aledade only succeeds when our partner practices succeed. From our cutting-edge technology platform to practice transformation services, we provide physicians with everything they need to create and run an accountable care organization (ACO), revamping the way they practice and getting them back to where they should be: quarterbacking their patients' health care! Our customized solutions help clinicians in communities across America preserve their autonomy, deliver better care to their patients, reduce overall costs, and keep independent physician practices flourishing.

Industry

Health care and social assistance

Company size

501 - 1,000 Employees

Headquarters location

Bethesda, MD, US

Year founded

2014

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