Payer Data Operations Manager

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The role includes troubleshooting and resolving data issues across multidisciplinary teams responsible for ensuring the integrity and operational health of key data pipelines. This individual will own data procurement and related communication with payers, directing inquiries to the appropriate Privia health teams. This position involves interfacing directly with payers to understand and design payer data exchanges supporting Privia’s various business lines. Additionally, this role will research complex data and process questions, identify root causes, and interact closely with business users and technical resources to drive data-related decisions. Collaborate with medical economics, product engineering, and market-based teams, as well as external stakeholders, to drive operational excellence and maturation of data operations.

• Oversee completion and communication of all new payer contract data procurement activities

•  Monitor & manage successful completion of monthly data operations calendar; including awareness and

• proactive resolution of changes or break/fix scenarios

• Develop and achievement SLAs for new/update/break-fix scenarios

• Collaborate with engineering and analytics teams to align priorities, resolve issues, and adherence to internal standards

• Serve as the business owner for data processing activities and complete all necessary requirements to ensure implementation into appropriate environments

• Maintain close alignment with market representatives to proactively identify and address needs and drive value and efficiency

• Work across teams to perform appropriate audits to close the loop across internal systems and between Privia and payer partners –example: confirmation of receipt (file delivered) and verification of expected impact (e.g. payer processed data and measure result changed)

• Manage administrative processes required for payer portal access

• Monitor payer programs to proactively adjust data operations as needed.

• Lead meetings to influence and consult both internal and external business partners on data operations

Qualifications

• 3+ years of healthcare experience

• Experience in working with and understanding health plan data files, record layouts and data content

• including but not limited to: 1) attribution and care coordination files 2) detail claims files 3) detail quality files 4) payer risk adjustment files.

• Experience with large payer files from United Healthcare, Blues plans, Aetna, Cigna and Humana preferred.

• Working knowledge of healthcare-related business functions such as claims processing, eligibility/attribution processes, quality metrics/measurement, value-based care, provider data management/credentialing

• Ability to define and execute day-to-day activities; report progress, raise issues, and seek alignment with direct supervisor and cross-functional teams

• Ability to identify or receive issues and drive to resolution, collaborate with other functional teams on more complex issues

• Strong ability to understand and express complex business processes and technical concepts effectively

• Experience operating effectively in a highly regulated environment (e.g. HIPAA, SOX)

• Strong organization skills and attention to detail

• Self-motivated with the ability to meet deadlines

• Eager to learn and adapt in a fast-paced, changing environment

• Ability to multi-task and manage competing priorities effectively

The salary range for this role is $100,000 to $125,000 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 15% & restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.