Director, Payer Operations
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.
We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
Your Role
As a Director, Payer Operations with Evergreen Nephrology, you're responsible for leading and executing key business processes to enhance efficiency and effectiveness in managing a diverse portfolio of health plan contracts. This role involves strategic leadership, operational optimization, and cross-functional collaboration to support value-based care initiatives.
Role Responsibilities
This role's primary duties include the following :
Leadership & Execution
- Lead complex operational initiatives including practice rostering and policy development.
- Manage a cross-functional team overseeing contract lifecycle management in collaboration with Strategic Payer Partnerships, Legal, Product, and other departments.
- Drive operational excellence, team productivity, and a strong team culture.
Operations Optimization
Establish and enforce reliable processes across all stages of contract participation (eligibility, roster submission, reconciliation, withdrawal).Improve workflows for both existing and new contract flows.Implement audit reporting and error-intake processes to proactively detect and resolve discrepancies.Lead, organize and implement monthly and quarterly joint payer meetings.Collaboration with Key Stakeholders
Partner with internal teams to build systems and tools for accurate roster management.Represent business users in product design and developmentCoordinate with teams to ensure data accuracy and alignment with practice rosters.Other duties consistent with this role, as assigned.
Required Qualifications
Bachelor's degree in healthcare or related field.10+ years of experience in healthcare operations, including payer contracting or provider credentialing.68 years of management experience.Strong leadership and stakeholder engagement skills.Excellent organizational and analytical abilities.Proficiency in contract management systems (CRM)Strong verbal, written, and presentation communication skills.Intermediate skills with MS Office Suite of products including Outlook and TeamsAble to work effectively in a primarily remote environment :Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommendedEvergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their roleEmployees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA informationPreferred Qualifications
Master's degree in healthcare or related field.Experience with value-based contracts.Compensation
The pay range for this role is $150,000 to $175,000 annually. Exact pay is determined based on experience, education, demand for the role, and other role-specific factors.
This role is also eligible for an annual bonus.
Benefits
Evergreen Nephrology's total rewards program is designed to support you in and outside of work. You can expect :
Paid, flexible time off12 paid holidays per yearMedical, dental, vision and life insurance, including an HSA with employer matchReimbursement for continuing medical education for eligible rolesA 401(k) program where Evergreen matches up to 4% of contributionsPaid parental leaveA robust training and development program that starts with onboarding and continues throughout your career with Evergreen NephrologyEvergreen Nephrology is an equal opportunity employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition or any other protected category under local, state or federal laws.